International ACHE Profile:
Ravindra V. Karanjekar, DHA
Group Director, Medical Services, Global Hospitals
CEO, Mumbai Global Hospital
Q: Tell us briefly about your background in healthcare management.
A: I completed formal education in both orthopedics and hospital management and started working in medical administration 20 years ago. I gradually equipped myself with financial and legal expertise and also knowledge of IT and computers. In addition, I’ve worked on systems and quality and successfully received JCI (Joint Commission International) accreditation for Wockhardt Hospitals Ltd. in Mumbai.
Q: How did you arrive at your current position?
A: I gradually moved from medical and hospital administrator to chief administrator, to medical director, and then director of business development. I was further promoted to vice president, then group director of Medical Services and CEO of Mumbai Hospital, of Global Hospitals. I worked with different hospital models, from charity to teaching, to gain experience. Now I head a chain of hospitals. Similarly, in focusing on quality in healthcare, I achieved the position of chairman of the accreditation committee for the Quality Council of India. I also am a principal assessor for NABH (National Accreditation Board for Hospital & Healthcare Providers) accreditation.
Q: What are your primary job responsibilities?
A: As CEO of Mumbai Global Hospital, I am responsible for profit and loss, manpower recruitment, systems development, quality, marketing and commissioning. I also oversee consultant activities and monitor various clinical indicators. In addition, I help in developing new specialties across the group.
Q: What is the biggest challenge you face in your current position?
A: Finding the skilled manpower to match the growth of our hospital chains is a big challenge for us. Skilled medical doctors with various backgrounds are scarce—we are counting on the reverse “brain drain” from the U.S. and the U.K. The rising cost of healthcare is another challenge, as is the conversion to electronic medical records, which requires a good management information system. Also, the lack of good simulation centers within training facilities is an issue we are facing.
Q: What is the biggest reward?
A: With limited resources I am able to successfully launch various hospitals in the country–all different models, from charity to corporate hospitals and teaching hospitals. I also am able to reach out to the poor and needy with the best technology. In addition, my management skills and leadership could contribute to inclusive growth in healthcare; financial success was the key to this achievement. To be a Member of ACHE is also a proud moment for me.
Q: Briefly describe the overall healthcare atmosphere in India.
A: India is the largest democracy in the world, and the country’s population is more than 1.3 billion people spread throughout rural and urban areas, 60:40 respectively. The healthcare facilities in some of the rural areas are still not accessible. Of the 1.3 million healthcare providers in India, 97 percent of them are unorganized and fragmented. Thirty-three percent, mostly located in rural areas, are not registered with the local health authority.
Q: How do you see healthcare management changing in the next five years?
A: With an 8-10 percent national gross domestic product (one of the highest in the world), India is poised to take off in all fields; healthcare is no exception. More hospitals will engage in super-specialty work, and with new policies put in place by the Indian government, there will be opportunities to build more nurse, doctor and paramedical branches.
Higher expenditures by at least 30 percent per year on healthcare for the next five years is expected. Seventy percent of hospitals will adopt quality processes and national accreditation, and more bilateral exchange of knowledge across the globe will occur. Also, clinical research will be much stronger and disease-focused.
Q: What advice can you offer for other international affiliates?
A: Quality and patient safety should be the central point of all decisions, and you should seek more knowledge across the globe to enable you to run your organization. The healthcare executive is one of the pillars of healthcare; he is not the boss, but he is a coordinator, protector and “head of the family,” making decisions conscientiously. Be humble and approachable and add value to others’ lives as well as to the organization. Do your job ethically and honestly and success will follow you.
Planning for the Unexpected
Learn what insights the earthquake in Haiti, the pandemic influenza outbreak, and other recent health crises gave us into improved disaster planning and emergency preparedness.
By Megan Downey
When the Scripps Medical Response Team touched down in Port Au Prince, Haiti, a week and a half after the earthquake, there was virtually no government, minimal law enforcement and the United Nations was operating out of the airport. The police headquarters and the health ministries had collapsed, and all of the country’s healthcare leaders had been killed.
“Haiti was not capable, even the U.N. was not capable, of taking care of the hundreds of thousands of people who were killed,” says Scripps Health President and CEO and ACHE Chairman Christopher D. Van Gorder, FACHE, who traveled to Haiti with the team. “I’m not sure that as a country they had the resources to be any more prepared than they were. They rely on international assistance.”
But what if you can’t rely on international assistance? What if your organization faces a pandemic like the H1N1 influenza, where other countries are faced with the same and have to provide care for their own?
“Nobody was really prepared for a highly lethal infection or something that required high hospitalization rates, the U.S. included,” says Nancy Thompson, FACHE, president, Health Care Insights LLC, who’s conducted extensive research and given multiple educational sessions on pandemic influenza. “It’s a societal problem and an economic problem, not just a health problem.”
According to Thompson, when H1N1 was announced as a level 6 on the World Health Organization (WHO) scale, the public associated it with high lethality, when in fact, the designation indicated high transmissibility and low lethality. As a result of the confusion, WHO now operates on a matrix that includes measurements for both factors. But how do you educate the public without creating panic?
Whether it’s a localized natural disaster or a global health crisis, all healthcare organizations need to have strategies that extend far beyond the walls of their hospitals. Here Van Gorder and Thompon suggest some preliminary steps.
Use an All-Hazards Approach
Plan for every disaster, keeping in mind what’s most likely to occur. The Haiti earthquake was devastating because the country’s construction techniques accounted for strong winds from hurricanes, not extreme seismic activity.
Look at Your Infrastructure
In the event that power is lost, how reliable are your backup generators? Are they located in an area that’s as susceptible to natural disaster as the rest of the hospital? (In the case of Hurricane Katrina, backup generators at many hospitals were located on the ground floor, making them useless during a flood.) What about your telephone and/or Internet hookup? If these systems are compromised, do you have a backup communications resource?
Work Within Your Means
For economically-challenged companies, it can be as simple as educating the public about standard procedures such as using a 10 percent bleach solution for all items that could be exposed to a virus. For others, it can be purchasing reusable equipment that might cost more up front, but will ultimately save time and money during disasters. Understand that disaster planning/emergency preparedness is an investment, and then look at your resources to figure out how to realistically address the issue.
Develop Key Relationships With Suppliers
Most hospitals are supplied to run self-sufficiently for 72 hours, but you can’t count on that. And hospitals can’t afford to stockpile in the case of an emergency. “Talk to your supply companies and ask them what they’re willing to do for you in terms of keeping a bulge in the supply chain,” Thompson says. “At the very least, you should be exploring that.”
Reach Out to the Community
Form relationships with other organizations in your community to help educate the public about natural disasters and emergency preparedness. “Hospitals are the knowledge center for infection control,” Thompson says, “but they don’t have to be the instructors.” Tap into existing public health or humanitarian organizations in your area with similar goals and purpose. The International Committee of the Red Cross has links to affiliated organizations throughout the world.
Paper Drills Won’t Cut It
In a disaster, you can’t work alone. The response needs to be coordinated with the police, fire department, gas companies and other agencies. Training needs to reflect the same multi-agency approach.
Prepare Mentally and Strategically
Your staff has to be able to function in a disaster. With a sudden, exponential increase in patients, the last thing you need is a reduction in workforce. Keep your employees informed, build a sense of security and assure them that the safest place to be in a crisis is at the hospital. “You need to train people in austere conditions with minimal equipment so they’re still able to function and maintain their sanity,” Van Gorder says. “It’s basically like deploying the military into a war zone.”
As a result of the increased awareness about this issue, the Pan-American Health Organization recently made disaster planning an international priority, offering numerous resources to help healthcare organizations before, during and after a disaster. Access these resources here: http://new.paho.org/disasters/?lang=en.
For further guidance and materials on disaster planning/emergency preparedness, visit the following sites:
World Health Organization: www.who.int/en/
United Nations: www.un.org/
Federal Emergency Management Association: www.fema.gov/
Below are new, timely ACHE resources such as books, study courses and websites to help you excel in your career.
Building CEO-Board Relationships That Last
The adverse effects of CEO turnover on a healthcare organization include threats to pursuing the organization’s mission, negative effects on hospital-physician relationships and additional drains on the organization’s staff and financial resources.
To help identify proven approaches that can benefit hospitals and their boards, The Synergy Organization, a national metrics and evidence-based healthcare executive search/leadership assessment firm based in Bensalem, Pa., conducted an in-depth research study to identify what strategies CEOs use with their boards to increase longevity and success.
From this data, The Synergy Organization created the “Six Building Blocks of Lasting Leadership.” The components of the model are summarized below:
(1) Leadership: In rallying others to build a better future, the most effective leaders create a clear and compelling vision that everyone can understand.
(2) Relationships: The willingness and ability to proactively interact with one another in a reciprocal manner to share information and promote mutual gains is critical to organizational success.
(3) Communication: This component focuses on clear, open and transparent conversations with people at all levels of the organization. CEOs must be viewed as approachable, and their words and actions must support the hospital’s mission consistently.
(4) Selection: Effective selection is defined as the systematic process of surrounding oneself with talented colleagues and applying their individual strengths to promote measurable gains toward achieving established goals.
(5) Measurement: CEOs of the most successful organizations use a variety of objective metrics to evaluate their team processes and progress to maximize efficiency and productivity.
(6) Flexibility: Effective leaders keep one eye on the future, are dissatisfied with the status quo, and are committed to moving their organization forward.
Adapted from “Building CEO-Board Relationships That Last,” by Kenneth R. Cohen, PhD, October 2008, Trustee magazine. Click here for a full copy of this article.
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