leadership & human capital development in healthcare people hosp orchid dr dev taneja aug2012
Post on 26-Jan-2015
107 Views
Preview:
DESCRIPTION
TRANSCRIPT
Leadership & Human Capital Development in Healthcare - Issues & Challenges
People HospHotel Orchid, Mumbai. 29th Aug 2012
Dr Dev TanejaM.S.(Gen.Surgery)
MBA – Healthcare Mgt. (NUS Business School, Singapore)
Director TachRoyal Healthcare Consultancy Services
Navi Mumbai
Performance Improvement
• Performance – Clinical, Operations & Finance
• Utilisation Reviews & Trend Analysis
• Human Capital Review
• BPR / Change Mgt.
IT in Health
• HIS
• ERP
• Business Intelligence / Health Analytics
• State / National Health Information Network (SHIN / NHIN) for Public Health
Quality & Service Excellence
• NABH / NABL
• JCI
• Service Excellence Culture
Strategic Business Consulting
• Planning & Positioning
• Marketing Strategy
• Balanced Score Card
Healthcare & Hospital Planning
• Formation Reports
• Commissioning
• Roll Out & Stabilisation
• Facility Up gradation
• Expansion
Leadership & Human Capital Development
• HR Strategy & OD
• Leadership & Management Development
• Training & HC Development
Our Service Offerings
2TachRoyal Healthcare Consulting Services
Indian Healthcare Sector
The Indian Healthcare sector is growing at 16 % per annum and is worth about $ 45 billion
(PE pulse on Healthcare & Life Sciences, Venture Intelligence Report. July 2009)
FICCI – E & Y Report
CII – Mckinksey Report
3TachRoyal Healthcare Consulting Services
The General Environment
• Low Public Health Spend
• Strong GDP Growth
• Per Capital Income - > $ 1000
• Rapid Urbanization 30 to 50
• Rapid Industrialization
• 100 % FDI in HC sector
• Tax Incentives against
investments in hospitals
• Literacy is increasing
• Growing Health Awareness
The Healthcare Environment
• Health Ins. CAGR 35 %
• Hospitals CAGR 12 to 15 %
• Non hospital based HC segment – 70 %
• Major Players –Tertiary Care Focus
• No Strong Player – Secondary Care
• Uptrend in Life Style Diseases
• No Major Player – Providing Integrated
HC services in HC Value chain
• Shortage of Hospital beds
• Accreditation – NABH, JCI
• Informed Consumer demands
“ NOT ONLY CURE BUT CARE AS WELL”
• Increasing Ability to Pay
• HC has become a viable business
• Limited No. of National / Regional Players
• Low Industry Maturity
The Healthcare Environment in India
4TachRoyal Healthcare Consulting Services
The Hospital Business Groups in India
National Level - Apollo Hospitals
- Fortis Hospitals
Regional - Max Healthcare
- Care Hospital
- Manipal Healthcare
Newer Capital Light HC Models
- Vasan Eye Care
- Nova Medical Centers etc.
5TachRoyal Healthcare Consulting Services
PRE- SERVICEMarket/Marketing ResearchTarget MarketServices offered/BrandingPricingPromotionDistribution/Logistics
POINT-OF-SERVICEClinical Operations
QualityProcess Innovation
MarketingPatient SatisfactionProduct DevelopmentMarket DevelopmentPenetrationEnhancementDifferentiation
AFTER-SERVICEFollow up
ClinicalMarketing
BillingFollow on
ClinicalMarketing
ORGANISATIONAL CULTUREShared Assumptions Shared Values Behavioral Norms
ORGANISATIONAL STRUCTUREFunction Division Matrix
STRATEGIC RESOURCESFinancial Human Information Technology
The HCO Value Chain
SERVICE
DELIVERY
SUPPORT
SERVICES 6TachRoyal Healthcare Consulting Services
Strategic Resources
Healthcare will emerge as one of the larger sector providing employment in India
Human Resource requirements change depends on whether the organisation is expanding, contracting, or maintaining scope
Either you have to impart training or recruit people with newer skill sets
TachRoyal Healthcare Consulting Services 7
Competing on Excellence
The New Basis of Healthcare Strategy
TachRoyal Healthcare Consultancy Services
• OrganisationArchitecture
• Systems & Processes
• MIS
• HR
• Finance
• IT in Health
• Strategic Alliances
• Clinical Quality
• Service Excellence
• Technology
• Marketing
• Payors
• Vision, Mission & Goals
• Benchmarking
• Balanced Score Card
Corporate Planning & Positioning
ClinicalProgramsPhysicianEngagement
OrganisationStructure, Values & Culture
Strategic Resources
Strategic Business Planning
9TachRoyal Healthcare Consulting Services
10TachRoyal Healthcare Consulting Services
Dr Dev Taneja’s SPM Model
REPORTS
SOP
SYSTEM
Structure Process Manpower
Building
Equipments
BALANCED GROWTH OF HOSPITAL (S)
ERP
Tools & Training
11TachRoyal Healthcare Consulting Services
Emerging Challenges in the Healthcare Sector
12TachRoyal Healthcare Consulting Services
Evolution of Health Financing in India
• Financial Risk with Patients
• Seller (Health Provider - Hospital) Power High
• Low Buyer (Patient) Power. Forced to buy services per Sellers inflated Tariffs
Out of Pocket
• Financial Risk with Health Insurance Cos
• Seller(Provider) Power remained High
• Hospitals worked on Cost Plus Models leading to high payouts by Insurance Cos there by threatening health insurance industries viability
Introduction of Health Insurance
• Health insurance Buyer (Payer) Power has increased
• Fixed Tariff to qualify as Preferred Provider Network Partner
• Majority of Hospitals after initial resistance signed Fixed Tariff Rate List of Insurance Industry (GIPSA)
• Financial Risk shifted to Providers (Hospitals)
Pro Active Health Ins. Cos
1986
2010
TachRoyal Healthcare Consulting Services13
Existing Healthcare - Cost Plus Model
• Being Effective was enough
• No Costing Challenges for business viability
• Hidden inefficiencies in hospitals
• HIS – Mostly Transaction oriented
• Performance Improvement – Patchy. Limited Enterprise Focus
Emerging Healthcare - At Cost Model
• Not only Effective but Efficient as well
• Service line Costing – Financial Discipline for business viability
• Empowered & Engaged Employees
• Clinical Quality & Service Excellence
• Strategic Application of IT for Performance Improvement
TachRoyal Healthcare Consulting Services 14
15TachRoyal Healthcare Consulting Services
16TachRoyal Healthcare Consulting Services
Highest PE Investment in Healthcare – Jan to June 2012 is USD 749 millions
( Care H – 110m, DM H – 100m, Vasan EC – 100m, Specialty H – 77m,
Super Religare – 66m & Nova Medical Centres – 54m)
( IT & ITES – 601m, BFSI – 501m, Energy – 414m, Manufacturing – 156m)
Source: PwC Venture Intelligence Report Data. ET, Mumbai 24thAug 2012
Active
• Involved in Management
• Involve Partners with rich industry experience
• Ramp up the business model
• Improve valuations
• Exit with superior returns
• Examples In Healthcare 1. Hospital Corporation of America, USA – KKR, Bain Capital, Merill Lynch 2. Parkway Health, Singapore -Texas Pacific Group (TPG)
Passive
• Passive Patient Investors
• Don’t involve industry experts in the team
• Get involved once signs of financial distress or erosion of value becomes apparent
• Later the new found activism by the fund managers is not appreciated by the promoters leading to acrimonious relations
• Exit with sub-optimal or even negative returns
• Common experience in India with investments in Healthcare vertical
Investment Returns – Based on Involvement of Fund Managers
17TachRoyal Healthcare Consulting Services
• Str. Alignment - Mission, Vision, Goals, Positioning & Branding
• Reactive / Ad Hoc Decision making
• Don’t appreciate the challenges of the scaled up business modelStrategic Focus
• Weak organisational Culture, Values & Governance
• Inability to attract & retain talented professional managers & other manpowerLeadership & Governance
• Low organisational maturity and Weak Org. Support Structure
• Effectiveness Vs Efficiency – Clinical, Operational & Financial
• Limited Project Mgt. Skills – Project delays leading to time & cost over runsSystems & Processes
• Limited use of IT for improving productivity, monitoring & control and decision making
• HIS systems capture only transactional data. No ERP / BIIT in Health
• Accreditation Reactive. Clinical Quality Outcomes not benchmarked
• No strategic development of Organisational Service Culture
Clinical outcomes &
Services Excellence
• Promoters don’t appreciate the investor’s concerns for superior value creation and time bound exit concerns
• Post M & A integration issues - Culture, Systems & Processes, HR etc.
Variance in Promoter & Investor Expectations
Post Investment – Investor Pain Points vis-a-vis Promoters
18TachRoyal Healthcare Consulting Services
19TachRoyal Healthcare Consulting Services
Hospital Cost Structure
EBITDA Margin
All figures as a % of Gross Hospital Revenue
Hospital Cost Structure
17.7%
22.6%
1.5%
7.1%13.0%
10.6%
6.1%
5.4%
15.9%
EBITDA Labor Expenses & salaries M arketing & PR
M aintenance Pharmacy Consumables
Utilities Administrative expenses Doctors Share
Operating Margin
20TachRoyal Healthcare Consulting ServicesSource: E & Y
Human Resources: Synopsis
Human capital is the fulcrum of healthcare services. The Indian tertiary healthcare segment, like many other service industries in the country, is faced with acute manpower shortages. The industry faces shortage of:
– Management cadre
– Doctors
– Nurses
– Technicians to support various services
Human Resources Spectrum in a Hospital
Technicians Nurses Doctors Management Others
Gap in nurses (2012)
929,8261,133,826
2,400,000
-
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
2006 2012 (E) Demand (2012)
1,2
60
,00
0
Manpower crunch is particularly felt in the availability of qualified nursing staff. It is pertinent to note that globally there is a shortage of trained nursing staff. An Ernst & Young study states that the country will be short of 12 Lakh nurses by 2012, if a target of 2 nurses per doctor is to be achieved.
As hospitals belong to the service industry, poor quality of services in terms of poor nurse to patient ratio, ineffective management or doctors shortage will directly impact revenues.
21
Source: E & Y
Human Resources: HR PracticesA significant number of trained manpower, particularly nurses, are leaving India for better career prospects. We believe the high attrition maybe due to:
•Lower domestic compensation levels
•Poor HR practices in Indian hospitals
Therefore, it is imperative for hospitals to take urgent steps to improve their internal HR practices and increase the HR personnel to hospital staff ratio.
Further, in professionalising hospital management, there is an urgent need to create a larger cadre of healthcare management professionals. Management by trained professionals will cause the necessary shift from doctor-led practice to service-centric management.
150
195
134
0
50
100
150
200
250
80-140 141-220 221-400
Number of hospital beds
Nu
mb
er
of
em
plo
yees p
er
HR
pers
on
Gap in Doctors (2012)
592,915
736,915
1,200,000
-
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
2006 2012 (E) Demand (2012)
46
3,0
00
22TachRoyal Healthcare Consulting ServicesSource: E & Y
According to the defined parameters, only nurses with GNM or higher qualification are allowed to practice in tertiary care hospitals in urban India. Coupled with serious shortage forecasted (shortage of 12 lakh by 2012) and their migration to foreign countries exacerbated by a global shortage of nursing professionals, this could seriously jeopardize growth of the healthcare industry
Availability of fully qualified nurses The average percentage of fully qualified nurses is 31%.
Human Resources: Qualification
31%
69%
Qualified nurses "Unqualified" nurses
Hospitals hire four different cadres of nurses:• Nurse Trainees: Unqualified “nurses”, trained on the job• ANM (Auxiliary Nurse & Midwife): Allowed to practice only in rural, under-served areas• GNM (General Nurse & Midwife): Qualified & allowed to practice• B.Sc Nursing: Qualified & allowed to practice & teach• M.Sc Nursing: Qualified nursing instructor
23TachRoyal Healthcare Consulting ServicesSource: E & Y
The attrition of nurses is a major cause of concern for the hospitals. The rate of attrition for trained ICU nurses is even higher.
The possible reasons being:
Hospital nurses perceive problems related to understaffing which effects the quality of care patients receive.
Nurses leave because of better salaries offered abroad.
High patient to nurse staffing ratio leading to nurse burnout.
High patient to nurse staffing ratios are associated with higher mortality rates, greater incidence of medical complications and errors resulting in poor job satisfaction.
Attrition of nursing staff The attrition rate of nurses across the hospitals is on an average 15% per year
Human Resources: Attrition
Worst
Median
14.17%
.06%
40%
15%
Best
Average
24TachRoyal Healthcare Consulting ServicesSource: E & Y
Human Resources: Attrition
0%
5%
10%
15%
20%
25%
30%
35%
40%
Attrition Rates
1 2 3 4 5 6 7 8 9 10
Hospitals
Nursing Attrition
25TachRoyal Healthcare Consulting ServicesSource: E & Y
A good surrogate measure for the quality
of ICU care is the nurses to bed ratio.
The median number of nurses per ICU bed in India is 1. Several hospitals are below this figure as well. The recommended standard is to employ 2 nurses per bed in an ICU, as outlined by the ISCCM (Indian Society for Critical Care Medicine).
The nursing patient ratio and the total number of nursing staff required by each unit depends on many variables. An artificially ventilated patient needs at least one nurse at the bedside at all times. A ventilated patient with more intricate support, such as, dialysis and inotropic support may need two nurses.
Considering the importance of an ICU to any hospital’s growth strategy, as pointed out in earlier sections of our study, and to provide a satisfactory patient experience, hospitals need to give due emphasis to this area.
The median number of nurses per bed in the ICU is 1.
Human Resources: ICU Care
Nurses per ICU bed
0
0.4
0.8
1.2
1.6
2
1 2 3 4 5 6 7 8 9 10 11 12 13
26TachRoyal Healthcare Consulting ServicesSource: E & Y
The recommended HR : employee ratio in other service industries is between 80-100.
Our interaction with hospitals has shown that poor emphasis on HR has led to low levels of job satisfaction in the industry.The relatively high attrition rates (in the vicinity of 15-20%) for nurses may be attributable to the same. Attrition amongst doctors, which also tends to be high, may also be partly attributable to the same, although there are other important factors, namely educational cycles and higher salaries elsewhere, which also come into play.
Apart from controlling attrition, HR plays a major role in;
• Talent Acquisition / Management
• Performance Management
• Reward Management
• Personnel Development
HR department plays a crucial role
in retaining certain employee
groups in hospitals.
The median ratio of total employees: HR personnel is 180:1
Human Resources: Management
150
195
134
0
50
100
150
200
250
80-140 141-220 221-400
Number of hospital beds
Nu
mb
er o
f e
mp
loyees p
er H
R
perso
n
27TachRoyal Healthcare Consulting ServicesSource: E & Y
Chapter Standards Objective elements
AAC 15 78
COP 18 105
MOM 13 61
PRE 5 30
HIC 9 46
CQI 6 39
ROM 5 25
FMS 9 43
HRM 13 47
IMS 7 41
TOTAL 100 515
NABH
28TachRoyal Healthcare Consulting Services
Healthcare Manpower - Fresh Talent
Like fresh Engineering graduates, majority of them are not adequately trained for employment
They need training at the induction level
Failure to have solid induction program leads to variation in
- Clinical Quality
- Service Standards
Even existing employees require periodic assessment, skill up
gradation & training
29TachRoyal Healthcare Consulting Services
Credentialing & Governing Bodies in Healthcare Sector
Except for doctors, nurses & para-medics there is no
credentialing / Licensing available for other employees in the healthcare sector
We don’t have well developed National Level Professional Governing bodies for other employees in the healthcare sector
e.g. 1) ACHE & FACHE for hospital Administrators
2) IT - CPHIMS
3) Finance - CHFP
4) HR - ASHHRA
We don’t have Organised forum’s to interact and learn from each others – Random events like People Hosp do take place
30TachRoyal Healthcare Consulting Services
Leadership
Governance
Values & Culture
People Alignment
31TachRoyal Healthcare Consulting Services
Definition of Organisational Culture
Shared Assumptions
Shared Values &
Behavioral Norms
( Control, Collaboration, Competence, Cultivation)
Maintain
Change
TachRoyal Healthcare Consulting Services 32
Competitive Organisation PosturingStrategically - REACTOR POSTURE
Reactor’s do not have a strategy or plan and are inconsistent & unstable in their response to environment changes
They lack consistent approaches to strategy & structure unlike proactive strategies of Defender, Prospector & Analyser
Such organisation’s are without a clear strategy or have a mismatch between strategy & implementation.
Evidence suggests that reactors are able to hone their competencies and transform themselves into more viable postures
Understanding the organisation’s preferred strategic posture & communicating it throughout organisation provides decision guidelines & it will also help to shape the culture of the organisation
33TachRoyal Healthcare Consulting Services
THREE MAJOR REASONS THAT ORGANISATIONS BECOME REACTORS
1. Top management may not have clearly articulated the
organisation’s strategy
2. Management does not fully shape the organisation’s structure & processes to fit a chosen strategy
3. Management tends to maintain organisation’s current strategy - structure relationship despite overwhelming environmental changes
34TachRoyal Healthcare Consulting Services
Service Excellence A Differentiation & Competitive Factor
Healthcare is a Service Industry
Service Excellence is a good business strategy
Patients today want “NOT ONLY CURE BUT CARE AS WELL“
Strong Customer experiences improves goodwill, demand & utilisation of hospital services
Directed towards both external & internal customers
Improves employee self esteem & productivity
Service Culture
Needs to be built across the organisation
Involves training and standardisation of service delivery practices
Its not one time exercise but a continues process
Requires continuous measurement and control
Its time consuming hence involving consultants optimises outcomes
35TachRoyal Healthcare Consulting Services
Personal Experience With Service Excellence Implementation
Total Employees – 403(Excluding Doctors)
Nos.
Less than 10th Std. 98 24%
12th & Diploma Holders 138 34%
Graduates 145 36%
Postgraduates 22 5%
36TachRoyal Healthcare Consulting Services
To Assess Initial Employees Soft Skills capabilities
HOD / In charge Level Survey was conducted
Confidence
Time Management
Leadership
Communication
Empathy
Attitude
Inter-Personal Skills
Information Management Skills
Patient Focus
Planning & Organisation
Innovativeness
37TachRoyal Healthcare Consulting Services
Initial HOD Soft Skill Assessment
Activity A B C
High Patient Interaction - Clinical 58% 26% 16%
High Patient Interaction - Non Clinical 30% 53% 17%
High Patient Interaction - Average 44% 40% 16%
No Patient Interaction 58% 32% 10%
38TachRoyal Healthcare Consulting Services
What is taught in Hospitality sector?
Building Service Culture 12 Hrs
Behaviour 6 Hrs
Communication 6 Hrs
Personality Development 9 Hrs
Grooming 10 Hrs
Scenarios - Hotel Industry 50 Hrs
Grievance Handling 10 Hrs
Satisfying Customer Needs 10 Hrs
Motivation / Leadership 6 Hrs
Note: This is done over a period of 6 to 9 months 39TachRoyal Healthcare Consulting Services
Leadership & Human Capital Development
How mature Healthcare Organisations are dealing with them?
Per HCO’s Mission & VisionThey have their Strategic HR planning in place
40TachRoyal Healthcare Consulting Services
41TachRoyal Healthcare Consulting Services
42TachRoyal Healthcare Consulting Services
43TachRoyal Healthcare Consulting Services
44TachRoyal Healthcare Consulting Services
45TachRoyal Healthcare Consulting Services
46TachRoyal Healthcare Consulting Services
Can We do it in India ?
Yes
Adopt & Apply
Balanced Score CardBenchmarking
47TachRoyal Healthcare Consulting Services
48
49
Board of Directors
Governance & Stewardship
Culture
Meritocracy
Employee Engagement
Human Capital
Job Design & Compensation
Talent Acquisition & Retention
HC Development
Capability & Competency
Learning Organisation
Leadership
Leadership Talent Pool
Succession Planning
Transformation & Change
Management
Job Provider Employer of ChoiceHR Positioning
Leadership & Human Capital Development
50TachRoyal Healthcare Consulting Services
Should We Interact briefly?
Thank You
Dr Dev Taneja
Founder & Director
• M.S.(Gen.Surgery)
• MBA – Healthcare Mgt. (NUS Business School, Singapore)
• Ex – COO, Global Hospitals
• Ex – VP – Planning, Systems & Strategy, Sevenhills Hospital, Mumbai
• Ex – Healthcare Executive , Parkway Health, Singapore
Mr. Pradeep Bapat
Director – Leadership & Human Capital Development
• Masters in HR
• Certifications in my SAP ECC 6.0 in HR, Change Mgt. & Employee Engagement
• Over 25 yrs of Industry Experience
• Ex – VP – Human Resources, Sevenhills Hospital, Mumbai
Team TachRoyal – A Group of Senior Healthcare Industry Professionals & Partners
Contact Info:
Dr Dev TanejaM.S. (Gen.Surgery), MBA – Healthcare Mgt. (National University of Singapore)
701, Viceroy ParkPlot No. 53, Sector 44ASeawoods Darave, Nerul (W).Navi Mumbai. 400706
Cell: +91- 9987708685E-mail: drdevtaneja@tachroyalhcs.com
drdevtaneja@gmail.com
53TachRoyal Healthcare Consulting Services
top related