Healthcare As Social Enterprise

4B Healthcare Hospital’s Process-Centric Operating Model

When a patient enters a hospital, whether they are conscious of it or not, they want four things to characterize their visit:

4BHC believes that the very best way to satisfy these patient objectives is through focusing on processes. Additionally, since a central part of 4BHC’s charter is to take failing mission hospitals and make them both fiscally viable and clinically excellent, we believe that through identifying, analyzing, and perpetually improving internal processes our facilities can accomplish these objectives most effectively.

Over the last 2 months since 4B took over Satribari hospital, we have been trying to put in systems and processes in place that will facilitate quick and lasting efficiency. To help us, we have had 2 workshops, attended by a core team from the hospital as well as from 4B- Me and Dr. Sudhin.

In the first workshop Mr. Babu Abraham, gave us a very thorough overview of structured process documentation and helped us understand how to document processes. In the second workshop Mr. Dale Westervelt spoke about process thinking and the need to having an overall picture of the various processes.

Interviews with the speakers and summaries will soon be up here, along with a lot of goodies on process documentation. So, watch this space!

Over the last decade or so, the focus has shifted from in-patient care to ambulatory care. Hospitals and other facilities are often rated based on their admission rates, readmission rates and length of stay. In general it is believed that frequent or high re-admissions are a sign of bad care. but perhaps there is another side

Hence, if a hospital has a lower mortality rate, then a greater proportion of its discharged patients are eligible for readmission. As such, to some extent, a higher readmission rate may be a consequence of successful care. Furthermore, planned re-admissions for procedures or surgery may represent appropriate care that decreases the risk of death, but this is not accounted for in Hospital Compare.

from Are All Readmissions Bad Readmissions? N Engl J Med 2010; 363:297-298July 15, 2010

This group of doctors raise some good points and deserve a better, detailed look.

Beginning today, once a week we will bring you a compendium of the most interesting science reads of the week. Here is Science Digest 001

• Turns out neurosurgery is not a recent advance of our species. As early as the Bronze age used to perform surgeries using obsidian blades.
• Also, if you thought pelvic massaging for hysterical paroxysms was a weird, you have to read the secret history of psychedelic psychiatry. Yes, it is exactly what it sounds like.
• You know that if you can resist a marshmallow you are set for success in your life, right? or are you? here are some very good questions and comments on the famous delayed gratification study in “C Is for Cookie”

Innovation seems to be the latest buzzword in the healthcare sector worldwide. In India, healthcare itself is a new buzzword; there is perhaps no sector in the Indian market whose growth and returns parallel that of healthcare. But as with any buzzword, there are a lot more organizations hopping the bandwagon of innovation for the sake of publicity and image than those that have an actual interest in the philosophy or practice itself.

Innovation means using a new idea, or making a new idea, revolutionary thinking or actions, not necessarily drastic, but with drastic effects. or following wikipedia

Innovation is a change in the thought process for doing something, or the useful application of new inventions or discoveries.It may refer to an incremental emergent or radical and revolutionary changes in thinking, products, processes, or organizations.

Technology and the way medicine is practiced are growing, sure, but not at a rate that can catch up with the demands of the people of meet needs. It is becoming increasingly obvious that some of the core beliefs around which health-dispensing were built around need to be re structured and even trashed. The world has changed and what healthcare often has to offer is far less or totally different from what people want

Without innovation, new expectations and problems, which are many and increasing by the day, cannot be answered. So governments too are trying to innovate of at least fund innovation

Depending on which side of the political spectrum you stand on, you might think that governments are great or awful innovators. In any case, we often miss that in the bigger issue of innovation and government we are all not asking or answering the same questions.

1. Should governments foster innovation?
2. Should governments have departments or ministries for innovation?
3. Are governments innovating or fostering innovation
4. How can governments innovate or foster innovation
5. When do governments need to innovate?
6. And how good are governments at innovating or fostering innovation

These are some of the questions commonly clubbed under “innovation and the government” while forgetting that the core issue is what you believe needs to be extent of involvement of governments in industry innovations.
There is no doubt about the question of should governments innovate. It is an “innovate or perish” world. Innovation is not or shouldn’t be something that happens when you face a crisis, or run into troubles, but a part of the operating philosophy of daily life.

In an article titled “Governments as engines of  Innovation”  Lisa Suennen talks about one such initiative by the US government of us for fostering innovation, she puts the need for innovation very beautifully

We need to nurture companies that come out of left field with disruptive ideas that blow up conventional wisdom and replace it with completely new ways of doing things, particularly thing that impart convenience, personalization, health-optimization and cost-effectiveness into the healthcare equation.

Innovation also implies change, in fact often innovation is just change. Therefore the need for not just new ideas, but wholesome and widespread restructuring, dismissal of old structures and re-examining of core beliefs.

Among the key objectives that the administration has discussed is how to transition the collective mindset from one of healthcare to one of health. In other words, if a person is healthy, they do not need health CARE. This is a very important distinction; it puts the emphasis on prevention and wellness as opposed to what you do when somebody is already sick. In order to affect such a transition, there must be an emphasis on innovation to change the way we have traditionally looked at the healthcare world.

You might not, like me, agree that health-initiatives for making a healthier world are not healthcare, or that healthcare is limited to hospitals and other traditional care dispensers. I believe that instead of shrinking the role of care to just the sick, care needs to extend into prevention and wellness. But it is obvious that some serious thought about what this business and profession is all about now.

There is no guarantee (in fact it is outright impossible) that the same ideas a beliefs that propelled healthcare giants to where they are now will help them capture the markets of tomorrow. But at least some of them are well equipped to handle such change. Are they willing is another question altogether

Will today’s healthcare giants be tomorrow’s healthcare leaders? Good question, but not likely unless they are willing to reinvent themselves completely—something very hard to do. It’s a little like shooting your dog because he’s ugly, even though he gave you years of companionship.

The comments to this piece are definitely worth a read, though few of the commenter’s focus on what sort of innovations can be made, one post in particular lists some

• To reduce defensive medicine, we could take medical dispute resolution out of the hands of juries and transfer it to specialized health courts which would be empowered to hire neutral experts to sort through conflicting scientific claims.
• Access to robust, user friendly price and quality transparency tools that would provide actual insurer contract reimbursement rates for various services, tests and procedures provided by doctors and hospitals.

These are definitely worth thought and following up on.

The debate will range on in the US about all this, but here in India, I think we are in a uniquely advantageous situation, the government is awake, pro-market, and more importantly the market is huge and therefore hungry for innovation and new ideas. Their acceptance and viability will need visionaries and organizations that dare to do something different and adopt radical ideas and practices. The government in India has always followed the people, innovators and visionaries have set precedence’s and examples that the government learns and uses.

According to an IBEF report the Indian Healthcare industry is growing at an unbelievable 23% per annum and will touch $77 Billion by 2012. Most of it is going to mainline healthcare, with very little variation, and very little into innovative ventures. Therefore, time is ripe for both with capital and those with ideas to explore dare and make a difference.

What think you? should the government in India foster innovation, does it already ?

Image by Gіacomo

Nurses, at least in India, are perhaps the lest appreciated part of the medical team. In spite of the pivotal role they play in the healing of a patient, they are often given a step-motherly treatment by the medical establishment. These hindrances notwithstanding, there is no doubt that a spirit of enterprise and innovation among nurse is what keeps many a ward working smoothly.

How nurses can use social enterprise to improve service in health care is an exhaustive resource that explores social enterprises that nurses can get involved in and begin and how that will not only result in better care for patients but also better professional development for nurses.

There is the potential to bring in new money to expand and protect a service and factors can be identified by using
a framework like the EPOCH model (Entreprenurses, 2008). This is a process whereby founding nurses work through the following questions:

E – What are you EXCELLENT at?
P – What PEOPLE could benefit from doing the things you are excellent at?
O – What are the OUTCOMES on the people receiving the service?
C – Who would COMMISSION you for these outcomes?
H – HOW MUCH would these commissioners pay for these outcomes?

The EPOCH Model is not just for nurses, any one looking to make a difference but is daunted by the lack of business skills and networking can use it to grow.

On July 1st 2010 4B Healthcare took over the management of Satribari Christian hospital from the Council of Baptist Churches in North East India (CBCNEI). Dr. Lama, the General Secretary signed the agreement with the directors of 4B Healthcare.

The agreement is valid for 30 years, during which time the hospital will be known as 4B Satribari Christian hospital. 4B will strive to run the hospital with the highest standards of care and professionalism.

Here are some of the photographs from the function.

These are my links for July 22nd

• How to Build a Culture of Innovation From the Inside Out
• Do-It-Yourself  healthcare-The healthcare Blog
• Moral Health Care vs. ‘Universal Health Care’” by Lin Zinser and Paul Hsieh

Velocommerce is commerce that is dependent on the bicycle (from the French word ‘velo’ referring to bicycle).

These folks document innovative use of vehicles, and in India, what better an example than the humble bicycle that is adapted by everyone from the doodhwalla to the traveling salesman. Click through to the Velowala website for more pictures of Velommerce

The question for us medico’s is, how can we use bicycle innovation for meeting healthcare needs?

Bangladesh’s Info Ladies are an inspiration in a related field. These daring young women  ride out to villages armed with cellphones and netbooks and empower farmers and traders in remote regions using information.

So, what can India’s “bicycle innovation” for health-care be? Something breakthrough, wild and revolutionary!

Social enterprises are social mission driven organizations which apply market-based strategies to achieve a social purpose. The movement includes both non-profits that use business models to pursue their mission and for-profits whose primary purposes are social. Many commercial businesses would consider themselves to have social objectives, but social enterprises are distinctive because their social or environmental purpose remains central to their operation.

Rather than maximizing shareholder value, the main aim of social enterprises is to generate profit to further their social and or environmental goals. This can be accomplished through a variety of ways and depends on the structure of the social enterprise. The profit from a business could be used to support a social aim, such as funding the programming of a non-profit organization. Moreover, a business could accomplish its social aim through its operation by employing individuals from disadvantaged backgrounds or lending to micro-businesses that have difficulty in securing investment from mainstream lenders.

Many non-profit organizations see social enterprise as a way to reduce their dependence on charitable donations and grants while others view the business itself as the vehicle for social change. Whether structured as nonprofits or for-profits, social enterprises are simply launched by social entrepreneurs who want to improve the common good and solve a social problem in a new, more lasting and effective way than traditional approaches. They are conceived and operated by visionary entrepreneurs who recognize potential where others may not see it and who apply discipline, pragmatism, courage and creativity to pursue their solution in spite of all obstacles, toward a world that is more abundant, secure and inclusive for all.

Social entrepreneurs are individuals who pursue opportunities to create pattern-breaking change in inequitable systems, whether through social enterprises or other means. Many social entrepreneurs have launched their ideas within nonprofits, since that organizational form is already set up to advance social value. However, there are an increasing number of social entrepreneurs launching social purpose businesses by building a social or environmental mission into the DNA of their company. By contrast, social enterprise refers to an organizational movement that applies market-based strategies to achieve social change. The underlying motivation is a growing awareness that the scale of the problems we are facing today cannot be adequately solved by the traditional non-profit and philanthropic approach.

Further reading: What is a social enterprise? By Jonathan Bland

Source: Wikipedia

If you were to do a survey of the 200 odd mission hospitals in India you would think that this massive organization has been asleep for about 15 years, if not more. Most of them are stuck in the past, unable to keep up with the times and very few are relevant to the areas they exist in.

The discussion paper outlines what is wrong with the healthcare system in our country, as well as charts a road map for successful revitalization of mission hospitals in India.

Some of the key changes in healthcare in India the last few decades are:

1. Private healthcare has become the predominant healthcare provision in India with about 80% of the sick going to a private practitioner or a private healthcare facility.
2. Healthcare has become a profiteering commodity with a high return on investments. This has attracted considerable private investment into healthcare and related products. When investor returns are paramount, social commitment is often ignored.
3. Government health system has improved but is patchy. It is better in well governed states. However, increasingly government is privatizing healthcare and is entering into public-private partnerships. Privatization is here to stay and we need to come to terms with this reality.
4. Regulatory mechanisms are weak and are unevenly enforced or corrupt. Because of the demand from consumers stronger regulation will be in place over time. NABH and ISO are some the organizations currently implementing standards.

Sum total of all the above changes is that the healthcare system has become curative oriented, inequitable, impoverishing. This has made people around the poverty line and the lower middle class significantly vulnerable to higher morbidity and mortality rates.  Healthcare professionals are trapped in a system which does very little to provide them with personal significance and meaning.

Read it online courtsey of Scribd
Alternative Future for Christian Healthcare

Or you can download it here [Link]