From Strength To Strength

Karnataka's first tertiary care referral hospital, Manipal Hospital, Bangalore has always been on the frontier of advanced care. But of late, it has been recognised for its amicable employees and warm ambience, reports Rita Dutta

On The Frontier Of Medical Care: Manipal Hospital, Bangalore

Ask any senior medico or executive working in Bangalore about his experience in healthcare and inevitably the name of Manipal Hospital will crop up. The 600-bed centrally air-conditioned hospital has churned the best of clinical skills and incisive minds in the Silicon Valley of India and has emerged as one of the best training grounds in healthcare.

On the Airport Road, a stone's throw away from the HAL airport, stands the 14-storey Manipal Hospital, the flagship hospital of Manipal Health Systems. The centrally air-conditioned hospital is the first tertiary care multi-super speciality referral centre in the state of Karnataka. Started in 1991 by Chairman Dr Ramdas Pai, the hospital raised the bar on healthcare standards several notches higher, when public hospitals in the garden city were found to be inadequate to meet the needs of the burgeoning population.

What is unique and heartening about the hospital is the camaraderie. Each of the 275 dedicated doctors and over 1,700 support staff have been trained to greet patients and visitors with a disarming and warm smile.

The hospital is being acknowledged for its warmth and hospitality and winning the prestigious Golden Peacock National Quality Award 2005 in the service category is a case in point. The fact that this was the only time that a hospital bagged an award in this category speaks volumes about the lack of hospitality in healthcare and how Manipal Hospital has tried to usher in a paradigm shift.

The vision of the hospital is to be among the top ten "most admired" healthcare systems in Asia by 2010. And the hospital is taking steps to achieve that. It was the first hospital in India to bag a comprehensive ISO 9001:2000 certification spanning clinical, nursing, diagnostics, support and administrative services from TUV Rhineland.

The Turnaround

Recognition did not come overnight. Though the hospital was considered one of the premier institutes with good clinicians and cutting-edge technology ever since its inception, it was lacking in the genre of hospitality.

The importance of bonhomie was underscored only when R Basil took over the reins as the Director and CEO in 2002. Divulges Basil, "I did not find the staff warm and inviting, when I had previously visited the hospital. So, when I became the CEO, my agenda for that year was to instil friendliness." Basil started training programmes for the employees to realise his vision and also aided his action by installing 72 cameras in various areas of the hospital. The motive was to observe the interactions of paramedics with patients and devise suitable training modules based on them.

Cameras were not positioned in doctors' consulting rooms to protect patient privacy. The HR studied the behaviour of staff mainly during rush hours and special training was given to be warm and friendly to the patients. What was unique about the exercise was its carrot approach. "Nobody was reprimanded, but everybody was encouraged to change and given incentives for good behaviour," recollects Hari Narayan Sharma, Vice President, Manipal Health Systems.

"The hospital brought about the transformation in culture by first changing the attitudes of employee towards patients" - R Basil Director & CEO Manipal Health Systems

For the hospital, there are various steps to hospitality. "The hospital brought about the transformation in culture by first changing the attitudes of employee towards patients. Employees were first taught to treat the patients like customers and HR created training modules on customer orientation at all levels. After two years, in line with its vision, the focus was shifted to treating patients as guests. Having achieved this, now the hospital is working with its employees to treat patients like blood relatives," Basil says.

For the benefit of patients, the evening OPD timing was extended from 5 pm to 8:30 pm and also kept open on Sundays and public holidays. "Evening OPDs are a necessity for working people so that they do not have to take leave from work," Basil explains. The fruits of the efforts were immediate—there was 90 per cent growth in OPD numbers. From 400 patients a day, today around 1,200 patients flock to the various OPDs of the hospital.

To improve its performance, every year the hospital decides on a target/theme and spins strategies to attain that. For instance, the year 2004 was the year of utilisation, whereby the length of stay, mortality rate and clinical audits formed the focus. From an average of seven days of length of stay, the figures have plunged to 4.5-4.75. The nosocomial infection rate was reduced to 0.8 per cent. Equipment utilisation was also stepped up.

After achieving many such targets, this year has been selected as the year of loyalty. Like many other hospitals, Manipal Hospitals, Bangalore has faced attrition due to the boom of private healthcare in the garden city. Recently, part of its cardiology team left for Wockhardt Hospitals, Banerghatta, but Basil is unperturbed. "The patient load is increasing everyday. We are creating a sense of pride in our employees so that they remain loyal," he says.

That the hospital is on the right track is reflected in its 100 per cent occupancy rate and turnover of Rs 155 crore last year.

Various Departments

The hospital offers treatment in 43 specialities and sub-specialities; around 20 super specialties were added in (after) 2003. It offers seven (super-specialities) specialities.

The Manipal Heart Foundation (MHF): The 150-bed facility, spread over the ground, first, fourth, seventh and 11th floor of the hospital provides two state-of-the-art digital cath labs, four full-fledged cardiac OTs, nuclear cardiology lab, advanced non-invasive cardiac lab, electro-physio lab, advanced intensive therapy unit along with CCU and homograft bank.

The department can conduct 15 heart surgeries a day, in addition to 30 cardiac procedures and is recognised by the governments of Mauritius and Tanzania as a cardiac referral centre.

The department of interventional cardiology provides coronary angioplasty and stenting, multi-vessel coronary stenting, temporary and permanent pacing, balloon valvuloplasty, AICD and pacemaker implantation, electrophysiological implantation, electrophysiological studies and ablation, device closure of ASD, VSD and PDA and interventions for various congenital and valvular diseases. The department of cardio thoracic surgery conducts rare congenital and redo surgeries, apart from the routine bypass, beating heart and valve replacements. The department specialises in neo-natal cardiac surgeries and surgeries under total circulatory arrests. In adults, it handles rare cases like triple valve replacements, left ventricular aneurysm reconstruction, Bentall procedure, Ross procedure and surgery for aortic dissection.

Manipal Institute for Neurological Disorders (MIND): This 120-bed department located on the 1st, 2nd and 10th floor caters to all sub-specialities in neuro-sciences. In its first year of operations in 1992, it became the first centre to perform neuroendoscopy in stereotacy and deep brain stimulation for Parkinson's disease. It runs special clinics on Parkinson's disease and movement disorders, peripheral nerve disorders, craniofacial deformities and epilepsy. It is linked with imaging services (CT and MRI) and has modern neuro-diagnostic facilities like ECG, ENMG, evoked potential and tele-matic ECG in addition to dedicated neuro-trauma and stroke unit. The department has a neuro rehab centre, along with a sleep lab. Says Dr S Murali, Consultant Neurologist, "The neuro-rehab centre offers the services of a multi-disciplined team of physio-therapists, occupational therapists and neurologists."

Manipal Institute of Nephrology and Urology (MINU): MINU has the largest dialysis centre in the country, performing over 24,000 dialyses each year. It also has the pride of being the first centre in Karnataka to perform cadaver renal transplantation and has experience in chronic ambulatory peritoneal dialysis and is the first centre in the state to use automated peritoneal dialysis using a home care machine. MINU was the first lithotripsy centre in Karnataka with a programme for the non-invasive management of the stone disease. The department specialises in endo-urology and laparoscopic urological procedures and is the first centre in Karnataka to be recognised for training in nephrology by the National Boards. It has nocturnal dialysis for working patients.

"The department has satellite centres within the city, which provides care for less privileged sections of the society. The centre launched the first kidney helpline number (2520 4000) in the state for kidney failure patients. The centre has also introduced "dialysis on wheels" with mobile dialysis unit, which delivers dialysis services at the doorstep," Basil informs.

Manipal Comprehensive Cancer Centre: The department is equipped with hand-held Gamma Probe, which allows the surgeons to perform targeted sentinel lymph node biopsy, mainly in breast cancers and gynaecological cancers. It also facilitates Radioisotope Guided Occult Lesion Localisation (ROLL), wherein very small non-palpable tumours are biopsied using minimally-invasive techniques. The radiation oncology department has a precise digital linear accelerator, simulator, ADAX Pinnacle, among others. The medical oncology and haematology department offers bone marrow transplant programme. The department has recently commissioned Intensity Modulated Radiation Therapy (IMRT) for cancer treatment.

The equipment delivers a high dose of radiation directly to cancer cells in a very targeted way. The entire system costs US$ 2 million, and comprises a modern Linear Accelerator equipped with a special device called multi-leaf collimator having 80 leaves and an amorphous silicon Portal Vision. This allows it to deliver rations much more precisely than is possible with conventional radiation therapy.

ADAC optimises a treatment plan based on the physician's dose instructions and information about tumour size, shape and location in the body. The multi leaf collimator shapes the radiation beam and delivers the radiation in accordance with the treatment plan such that surrounding healthy tissues are maximally spared.

"IMRT has revolutionised the whole concept of radiation therapy and has made it possible to treat tumours that might have been considered untreatable in the past due to close proximity to vital organs and structures," says Dr Sanjiv Sharma, Head, Radiotherapy, Manipal Comprehensive Cancer Centre, Manipal Hospital.

The centre works closely with Medical Social Workers and psychiatrists to provide comprehensive psycho-social support for the patient and their family.

Other Departments: "The hospital has a unique department of physical medicine and rehabilitation, which offers neuro-rehab, sports medicine, ortho and trauma and rehab cases," says Dr Maheswarappa BM, Head, Department Of Medicine and Rehabilitation.

It also has an international institute of dental sciences, Manipal Diagnostic Services, Manipal Institute of Diabetes, Endocrinology and Metabolism.

The paediatric department was the first in India to introduce surfactant therapy for treatment of neonatal respiratory distress syndrome and also the first to organise a neo-natal transport system.

The 35-bed NICU is one of the largest NICUs in Asia. Says Pramila CS, Second In Charge, Nursing Staff, NICU, "The NICU is supported by 12 ventilators, 10 warmers and 10 incubators and supported by 35 nurses."

The hospital also has a telemedicine network, whereby medical information of patients located at remote areas is transmitted live. Medicos at Manipal view and help to decide the course of treatment.

Medical Tourism

With around 3,000 patients trooping to the hospital for medical tourism last year from 21 countries, medical tourism is a focus area. Which is why the hospital has dedicated a section of its 11th floor for medical tourism patients. The sitting area and the rooms in this floor have tastefully designed décor, sophistication and comfort. With better patient care in mind, the hospital offers interpreters for Arabic, African and Middle Eastern patients and arranges country-specific food for them on request. The rooms, which are singular in design, offer a panoramic view of Bangalore Airport and tranquillity of the golf course. The rooms are equipped with controllable air conditioning, reading lights, STD and ISD facility, channel music and colour television.

Even as medical tourism is a focus area, the hospital has not shirked its responsibility towards the poor. "Even the poor patients are treated like our guests," emphasises Basil.

Training and Research

The hospital has tie-ups with several foreign universities for post-graduate studies. Says Vascular Surgeon Dr U Vasudeva Rao, "We have education exchange programmes with Kathmandu, National Board, DNB, UK-based Royal College. Our staff receives 35,000 hours of training in hands-on skills and aptitude annually."

The institute is involved in research in various streams. A significant research is cell-based therapeutics using human adult stem cells or human embryonic stem cells for a wide range of disorders like various types of cancer, neurological diseases such as Parkinson's disease, spinal cord injuries and diabetes. The centre, which plans to recruit over 100 scientists by the end of this year, is conducting stem cell therapy for patients having undergone MI or with poor cardiac functions. The stem cells are extracted from the bone marrow of the patients. Says Dr Prathap Kumar, Consultant Cardiologist and Director of Cathlab Services, "We have done a few cases in trial basis. Though stem cell therapy is path-breaking, it is too early to talk about the success of these cases."

Future Plans

The hospital is adding 200 beds across all specialities in land adjacent to the existing building, where the helipad stands today. The new building will be connected to the existing one. "We are forced to expand as often there is a waiting list of patients for surgeries," Basil reasons.

The group, which has 13 hospitals in India, Malaysia and Nepal, is building another hospital in Bangalore. The 600-bed tertiary care hospital in Devanahalli will be built on 15 acres of land.

The departments of Nuclear Medicine and Radiology are coming up with Bangalore's first Fusion Imaging (PET and CT), 64 slice CT and 1.5 Tesla Twin Gradient, High Definition MRI system totally costing USD 7 million. The organ transplant department intends to start liver transplant and artificial heart transplant soon. In the pipeline are the departments of liver and digestive disease and robotic surgery.

What about JCI accreditation? "Yes, we are planning for it," says Basil. The hospital also plans to get listed within the next four to five years.

One walks out of the hospital, humbled.

rita@expresshealthcaremgmt.com