Ajay Deshpande, CTO, Rakya Technologies outlines the importance of adopting technology to automate hospital administration. He also debunks the myths and fears that generally hinder adoption of technology and elaborates on how hospital administration can be made more efficient and error-free
Picture this:
A policeman has stopped a typical ‘Tempo’ like vehicle in a semi-urban Indian setting. The driver gets down with a half salute and half smile to the policeman.
“How many people are you carrying?” the policeman asks.
“Thirty sir,” is the prompt reply.
The policeman is amazed and confused at the same time. Looking at his expression on how so many people could fit in such a vehicle, the driver asks everyone to get down. Yes, thirty people come out of that vehicle. With a last nod of amazed wonder, the policeman lets the driver go without a fine.
The Hospital Administrator in the semi-urban and rural Indian scenario is in a situation similar to the driver above. Yes, resources are limited – but one cannot leave behind the large number of patients arriving at their doorsteps for help. As India progresses, her spending capacity is improving, and is thereby setting some bar of expectations from the healthcare industry as a whole. It has become imperative today for Hospital Administrators to manage the affairs of the hospital with predictability and efficiency. It is not just about saving a life – it is about providing good healthcare. A common scene in India today is that of a doctor in the hospital playing the role of an administrator. This makes the situation even more significant. In this article, I would like to discuss the many aspects of this problem in India and how one can use technology as a cost effective way to address it.
Factors under consideration
While there are many facets to the Indian healthcare situation, it is important to note that sometimes it is tough to consider this industry a business, especially because it boils down to ‘saving a life’. It is surreal to worry about efficiency in a situation like this – but truth be told, technology has come to the rescue of several such situations in the past many decades. And extending technology in the hospital administration realm is equal to taking the next step towards raising the bar of efficiency of a business invested in ‘saving lives’.
- Decreased patient satisfaction
If hospitals had to worry about only one thing, then it would be ‘ensuring uniform satisfaction for all its patients’. While healthcare can still be person dependent, hospitals can definitely take steps to avoid other frustrations for its patients. This will need to be through a combination of training, process improvements and technology implementations. - Issues arising out of non-compliance
Since healthcare is so people oriented, it can also become error prone. Human errors and lack of knowledge lead to non-compliances. If people involved are unlucky these non-compliances may result in serious issues. Non-compliances can occur in actual patient care as well as in record maintenance. Both of these could lead to governmental and legal complications. - Resource pilferage
Although no scientific research exists, it is common knowledge from the anecdotal experience at Rakya that unsupervised and undocumented procedures are quite open to theft. In some of the case studies conducted at Rakya it was seen that there are multiple ways to siphon off resources (right from hospital supplies to real money) without the knowledge of the hospital administrators. While one cannot completely eliminate it, theft can certainly be minimised. Hospitals need to implement checks and balances, close vigilance and a water tight process to control pilferage. - Non-scalable models
Many of the hospitals in India are family run and have achieved considerable success running that way. However many of them implement archaic procedures which become impediments to their growth. For example; hospitals are unable to treat more patients in a day even if they want to. Adding more doctors to a multi-speciality hospital does not lead to a proportional increase in revenue. These are symptoms of deeper systemic problems that pose large barriers to growth. - Administrative stress
It is common knowledge how stressful lives doctors lead. More so when the doctor plays the role of an administrator as well. With ever changing patient expectations, rising administrative pains, changing policies and the fact that hospitals run 24×7, it is no wonder that doctors are stressed out. A multi-pronged strategy is needed to control such stress.
Technology as an enabler
Technology can be key in tackling all these issues. Interestingly, healthcare in India has embraced technology in actual caregiving. Newer devices are being used and automated checkups are now available. But technology in hospital administration is still not very developed and has a lot of catching up to do. Patients still do stand in long queues to get registered. Patient discharge from IPD still takes more than half a day in such hospitals.
Why do these hospitals tend to not implement technology solutions in administration? In this section, we explore some typical causes as well as ideas to overcome such drawbacks.
Reason 1: A hospital management system (HMS) does not suit our situation
One of the most common things heard in the market is ‘automation does not suit our way of running the hospital’. ‘Our hospital is too unique to use an HMS’. This probably stems from the fact that the hospital was founded long back and processes that have worked for them for years are being used. While there is no harm in following what has worked, Hospital Administrators need to ask themselves, “Do we need to change?”, “Can I reduce the number of headaches/ issues we face today?” “How many of these issues result from inefficient processes?”
Answers to these questions are also closely related to growth of the hospital. Growth in terms of better patient satisfaction, better staff satisfaction, treating more number of patients in a day and so on.
It is a common fact that every situation is unique. It is very important to accept this fact. However, one needs to also consider the benefits of standardisation. For example; while every car is unique yet there is still so much standardisation that one hardly needs to learn anything to drive a new car for the first time. Similarly, while hospitals can preserve their uniqueness, they can standardise on a lot of processes that are commonplace. Here is where automation comes into picture. Further, if the HMS is good, it will be customisable for different situations. The take at Rakya is that there are no situations where automation does not help. It is just a matter of recognising the current state and understanding the end goal that one wants to achieve.
Reason 2: HMS is very expensive
It is natural for healthcare administrators to think that HMS systems are very expensive. This is however just a perception. These administrators are the same people who do not flinch an eye when buying medical equipment worth lakhs. Then, why is there a perception that HMS is expensive? From experience at Rakya it is usually not the cost that hospital administrators are concerned about. They do not have a good understanding of the value they get out of it. In other words they do not clearly understand the return on investment. It is hard for them to visualise how they will save money by moving away from pen and paper based systems.
Hence at Rakya, customers are first educated on how to understand the ROI plan. Even though the same software systems might be used, every hospital, every situation has a different way to achieve ROI. Convincing doctors about this ROI and then actually realising the savings, is part of typical consultative approaches to address customer needs.
Reason 3: Unavailability of trained staff
Another very important predicament that hospitals face is the shortage of the necessary personnel to run an HMS. While it is natural that there is shortage of skilled personnel in every walk of life, there are also a couple of under currents to this perception. The first aspect is that the HMS software is too complex to use. While the discipline of HMS is indeed complex, all users need not be exposed to all of it. HMS software can be made user-friendly by implementing role-based tailoring of the interface.
The second aspect why staff find it difficult to adapt to an HMS is that they are too comfortable with the pen and paper method. It allows them to change things as needed on the fly. This allows for the setting in of a lack of discipline. Computerisation however encourages ‘Do it right the first time’ culture. So, the training issue actually turns out to be a culture issue. So, hospital administrators need to introduce this culture change slowly. They need to find champions in their staff who can advocate this change and enunciate the benefits that the staff gain from the move.
Reason 4: Loss of confidence in the system
There are instances where hospital administrators have ventured to purchase HMS software but were unhappy with the outcome. They are typically sold an HMS by a fly-by-night operator and now do not get any support. The system being inadequate to meet their needs, is now gathering dust in a corner of the hospital. When such things happen, it is but natural that the administrators lose confidence in the system.
In such cases, it is important to understand that inexpensive does not always mean good for the hospital. In fact, as it turns out to be wasted money, the outcome turns out to be actually very expensive. Administrators have to first look for a vendor who makes them comfortable and is willing to listen to the problems that the hospital faces. Administrators should take active interest to understand the methodology used in deploying the HMS. They should invest larger amounts only after a certain trust level is built. Another key factor is to check the references. Talk to the hospitals that are already using the HMS and then make a wise decision. Getting frustrated by the system does not help; in fact, people need to realise that they are the system and they can change it by being judicious.
These are all very valid reasons to not opt for automation and probably there are many more. However, getting automation to work for you in the long run outweighs all of them. Hospital administrators need to look at this as there is no choice but to automate. In the process it is very important for them to pick the right system and the right vendor for their HMS. Actually, the right approach is not to look for a vendor, but to look for a long term partner. It is going to be a long term game to play.
The road ahead
While there are many impediments to implementing technology solutions for administration in a hospital, there are also solutions found over time. Most of the impediments are temporary in nature. What is thought of as a weakness can be turned into a strength. Technology solutions can increase patient satisfaction while at the same time reduce wastage and pilferage. The key things to change are the mindset and the culture in your organisation.
Factors Leading to Administrative Stress
- Decreased patient satisfaction
- Non-compliance related problems
- Resource pilferage
- Non-scalable models
Impediments to Implementing Technology Solutions
- HMS does not suit our situation
- HMS is very expensive
- No trained staff available to run the HMS
- Loss of confidence in the system
As India is on the cusp of being a developed nation, the expectations from the healthcare system are going to significantly increase. In many cases, hospitals will not be able to run in the same way they have been doing. They have to take a hard look at their goals and aspirations. Then, they have to chalk out plans on how to meet these goals.
Healthcare administrators can take advantage of companies like Rakya, who can provide them end-to-end solutions to automate their hospitals. Rakya also follows it up with business support services so that customers are not left out in the dark afterwards. Implementing automation helps increase compliance both in providing healthcare and in the administration of the hospital. These in turn help the Administrator to be more at peace and thus prepare for growth. In short, Rakya can be your trusted partner in your journey of ‘reaching for the stars!’
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