Nagar Panchayat HospitalGroup 10:

Jis Tom Sunny

Rizwana Gouse

Steeve Irimpan

V. S. Seeja

Vinod C.

Panchayat

• Situated in Vallabh Vidyanagar, Gujarat.• Elections were held once in every five years.• Elected members were responsible for the civic

amenities of the township.• Sub-committees of five members to oversee the

day-to-day operations.• Major source of revenue were from octroi (60%)• Major source of income from return on

investment, penalties, donations and borrowings.

Hospital

• Part of local civic administration.• Health committee was set up for solving minor policy

issues.• CMO was in charge of the day-to-day operations.• Objectives of the hospital

To provide domiciliary medical support to the residents of the township.

To undertake immunization services under the maternal and child health programme.

To undertake preventive programmes for checking outbursts of epidemics.

Cont…

• Sources of revenue were through fees and donations.

• Hospital had a total staff of 9 members and was done centrally.

• The challenge was to make it a self-sustaining unit.

• CMO floated a project for the students of a leading business school.

• Suggestive measures Pharmacy division- no proper inventory management

model Maternity unit- ensure that the occupancy rate of the

maternity ward is high Equipment purchase-investment for equipment should be

sought as a grant either from the Panchayat or from the state government or from a private donor.

• Implemented these recommendations in right earnest.

Growth of the hospital

• Occupancy rate had gone up.• Hired gynaecologist to visit hospital alternatively.• Labour room and the operating room for tubectomy were

renovated.• Investment for an ENT specialist, Sonography unit and ECG unit • Upgraded opthalmology division and public awareness

campaigns for population control, family welfare and polio prevention.

• Revenue from laboratory fees had more than tripled and the revenue from the sales of medicine had quadrupled, from around Rs.2.90 lakhs in 1993-94 to Rs.11.57 lakhs in 1998-99.

1987-88 1988-89 1989-90 1990-91 1991-92 1992-93 1993-94 1994-95 1995-96 1996-97 1997-98 1998-990

200000

400000

600000

800000

1000000

1200000

1400000

1600000

Dispensary Revenue

Dispensary Revenue

Areas of Concern

• Panchayat not ploughing the surplus back into healthcare.

• Cash donations to hospital going to general pool of panchayat

• Major decisions are centralized . Eg: Staffing• Operations now scaled up : Informal measures of CMO

will not provide the required results• What if the CMO leaves ?? Indicative of lack of proper

system.• Impressive Growth yet ….fragile foundation system

The Key Questions

• Existing System Vs Autonomy• Profits Vs Service• Sustainability of the system • One man show Vs Team Performance Putting all eggs in one basket?????

ANALYSIS

1. 7-S Framework2. Porters Five Force Framework

7-S Framework

• STRATEGY

Low Cost Low cost generic medicinesProviding facilities at 50 % of market price

• STRUCTURE

Panchayat Members

Health Committee ( 5 members )

Chief Medical Officer

Staff members ( 8 members)

• SYSTEM Inventory Management System

Financial System Deposition of receipts and Release of cheques for

expenses with the Panchayat daily. Surplus generated going to general pool for cross

subsidization Cash donations going to Panchayat

• STAFFING Understaffed Centralized Informal measures of staffing Requirement of staff to be more capable to meet

the increasing hospital demands.

The number of patient registrations has increased from 12000 in 1993 to 25000 per annum

• SKILLSMedical Skills, Administrative Skills

• STYLE Autocratic leadership style of the CMO Non-interference of the Panchayat in hospital

administration

• SHARED VALUES Providing quality healthcare at an affordable cost.

Porters five force model

• Threat of new entrants in the market

Moderate not low : what if a hospital emphasizing charity comesnot high : capital intensive.

• Bargaining power of buyers

Low income people: lowHigh income people: high

• Bargaining power of suppliersLow cost medicine : lowBranded medicine : high

• Threat of substituteModerate

• Rivalry among existing firmsLow

ACTION PLAN

• Initiative to be taken by the Panchayat to create a shareholding pattern for the Hospital.

• Elections conducted among shareholders to elect the board members.

• CMO on the board as a representative of medical staff.• Final decisions on policies and administrative matters to be

taken by this board. • Recruitment of a Secretary to handle daily administrative

duties• Recruitment of Doctors and Support staff by a panel of

medical practitioners.

• Recruitment : One year contract followed by permanent posting

• Surplus Allocation10% to Panchayat30% for infrastructure development in the hospital30% for growth (diversification)20% reach out (awareness) programme10% for employee welfare

• For Revenue generation : Attract patients towards primary services.Charges are as follows :General Consultation : Rs.4Special Consultation : Rs.10(Validity of the registration is for 3 weeks only)

Increase in Awareness Programmes and Medical Campaigns

vs

Existing SystemAutocratic leadershipHigh WorkloadNo team to support himNeed for empowermentNeed for Autonomy

Revamped SystemTeam of doctors Better Succession PlanWorkload reduced, Better Salary Better Empowerment Better DelegationBetter AdministrationBetter quality for low cost

Thank you