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By Vivek Shukla, Director, Healthcare & Lifesciences, Frost & Sullivan and Dr Fatih Mehmet Gul, MD, Chief Operating Officer, Fakeeh University Hospital
Creating infrastructure in healthcare is no mean task. Projects are usually large-sized and involve adherence to many standards, regulations and best practices. If thrown into this the challenge of economic viability, it certainly is a daunting task at hand. The undertaking of creating healthcare infrastructure that is sustainable and viable is not impossible, even though it is a tough challenge. To tackle this, here are a few learnings that we hope will be useful for people who want to manage these projects successfully.
We can say with considerable impunity, most hospitals that do not do well actually fail in the project conception stage itself. The importance of starting right cannot be stressed enough. You always start with getting the depth of demand right. The gap between what is required in the region that you are serving or looking to serve and what is already being provided has to be gauged as objectively as possible. “We have been in this business long enough to understand the gaps and there is no need for an in-depth objective analysis” is not an acceptable answer. The stakes in these capital-intensive projects are too high to be left to the ‘we know it all’ syndrome.
The demand study, among many other things, defines the following:
• Services that need to be provided
• Design required for those services
• Overall business model of the facility
• Available/unavailable service review for the market
• Technology and equipment that needs to be incorporated
• Local flavour that will need to be infused in the design and delivery of services
Once the demand depth is gauged, the team usually creates a brief on what is required from the overall design and delivery point of view. This brief is then part of all discussions with possible vendors and project partners.
Selection of partners can be another make or break decision for the project’s success. It is imperative to have project partners who have sound local knowledge and expertise in the overall concept that you have envisaged. There have been times when big international brands have been hired for projects and have failed to deliver, as they did not have the requisite know-how of the local markets and its regulations.
We always recommend doing a thorough background check on the project partners, even if it means spending extra days or weeks. Find out about the previous projects delivered by them and visit those places, apart from speaking to the teams that they worked with in those projects. Try and find similar projects as you have conceptualised for yourself. Be wary of partners who hesitate to provide details of contacts in previous projects. Firms that are in bad health financially must also be avoided.
Another key element in any hospital design and planning pertains to how seamlessly the technology integrates throughout the system. In the modern times, hospitals are heavy on technology and its interface with care delivery. For instance, a patient’s journey from the ambulance, to the emergency ward to the OT to the ICU must be integrated in terms of patient care data that can be seamlessly collected and transferred among all care points. The system should integrate the pharmacy and billing too, in addition to other things.
Beware of Buzzwords
Many a time, the promoters and project owners get smitten by the buzzwords that are doing the rounds. Be aware that not all predicted fads will become long-term trends. Have a realistic view and knowledge about what may become a necessity in future and what will pass away as a short-term fad. Just because people are talking about it in articles and conferences, doesn’t mean you spend millions in chasing those concepts. It pays well to objectively gauge the fit between your demand depth and the buzzword or new trend.
This is where the action actually takes place. The entire plan is laid out with pre-conditions and timelines. A common mistake made by project owners here is lack of communication among stakeholders. Not everyone knows all the details about the plan. In large projects, it has been our experience that over-communication is better than under-communication. If you have to err, do it towards over-communicating.
Information about the deadlines that are likely to be missed needs to be communicated as soon as the owner gets the first whiff of delay and not on the deadline date. This may sound counter-intuitive, but it builds immense trust and transparency among the team. Similarly, deadlines that will be met must be communicated boldly and loudly as well. This builds the momentum and encourages everyone else.
Another important factor is Change Control Management. Allowing changes during the execution of a project is the perfect recipe for delays. Design stage can have umpteen iterations, but once it is completed and frozen, changes allowed are to be very minimal to ensure on-time delivery of the project.
Get the Core Team Right
One common mistake often made is that the composition of the core project team is not adequate. For example, sometimes the head of operations comes into the picture only when he is handed over the building for commissioning. It is a bit late in the day if that happens. The senior operational team and senior medical team representatives should be part of the project from the very beginning. Some promoters think that hiring an operational team beforehand is an unnecessary expense, as the hospital is not even ready.
As it turns out, it may prove costlier to re-do a hospital after it is done wrongly, than to hire two senior people who will be running most of the project anyway once it is ready. They need to be a part of the bigger picture right from the start.
Cost vs Investment Mentality
This brings us to another related point. You have a choice in how to perceive the spending on various project-related items. Everything that is being conceived for the project can either be viewed as a cost or as an investment. A positive way to look at things is to see if they are an investment for the demand-based model that you are making. The investment can be dismissed if it either does not bring promising returns or it is inconsistent with the business model. Overall, having an ‘investor mindset’ is healthier and more rewarding than the ‘cost-saver mindset’.
To sum it up, in this article, we have tried to simplify in 7 points – a tedious, complex and a cumbersome process of conceiving, designing and building hospitals. The journey to create something new is exciting. It becomes even more rewarding when the project takes off on a successful note and adds the value that was envisioned for it.