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Sineflex Co-founder publishes an article on Medium!

  • Santosh Shevade
  • 12-Dec-2018
  • 0 Comments

Status of Healthcare Quality in Indian Hospitals

I was reading several aspects of the Indian hospitals ecosystem for a recent consultation that spurred me to jot down my thoughts.

According to IBEF ,the industry size in FY17 was Rs 4 Trillion (~ $62 Billion) and expected to grow by ~16%. Although the figure is minuscule as compared to the global hospital care market (More than $1 tr by some estimates), in India it accounts for approximately 30-40% of overall healthcare spend and hence holds significant sway. Changing demographic indicators, lack of qualified physicians, and a general trend away from general physicians will help hospital services to continue gain more and more importance in India.

With this background, it is no wonder that the hospital scene is going through a big churn. There is constant consolidation happening especially in the big private hospitals across India, regional and local levels. However most of the focus that I have seen so far seems to be of the private equity type: invest money, reduce operational expenses, increase bed utilization and so on. There is hardly any thought on what can be considered as excellence in healthcare services and understanding the need of the patient.

Lets look at the first bit-what are some of the global standards when it comes to service excellence? There are two notable examples here- OECD data on hospitals and the US Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

OECD already gathers and measures several indices on hospital services. Some examples of these metrics include-

  • Length of Hospital Stay (ALOS): OECD defines Average Length Of Stay as the average number of days that patients spend in hospital. It is generally measured by dividing the total number of days stayed by all inpatients during a year by the number of admissions or discharges. From the hospital and healthcare burden perspective, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. For patients, there is reduced risk of hospital acquired infections.
  • Hospital Discharge Rate: Per OECD definition, Hospital discharge rates measure the number of patients who leave a hospital after receiving care. Hospital discharge is defined as the release of a patient who has stayed at least one night in hospital. It includes deaths in hospital following inpatient care. Same-day discharges are usually excluded. This indicator is measured per 100 000 inhabitants. Once again, this indicator can help assess burden on the hospital system, seasonal variations and so forth

These and other types of indicators can be further stratified based on disease categories and demographics to generate valuable data insights both for patients and caregivers.


The US HCAHPS is a survey instrument that measures indicators of patient satisfaction. These indicators range from doctor responsiveness to caregiver impressions on the hospital services. The survey results are then used to provide a star rating which are available to general public.

These ratings are highly used in the US healthcare business, especially by payors and insurers and have thus become an important metrics for the hospitals.

An interesting element of the HCAHPS is that it tries to measure patient reaction to each medical encounter, thereby capturing important elements of the patient journey.

The above examples as well as several other indicators that are used globally for hospital service quality are not perfect. All of these face criticism and need constant improvement. However, there is an ongoing effort in gathering these data pieces, working on them and measuring them for real impact on patient satisfaction, which is missing on most parts for Indian hospitals.

What does this mean for service quality measures for Indian hospitals?

One of the first things that Indian hospitals, especially the private sectors ones, can do is to start thinking about the data that will need to be collected and gathered in order to reflect some of these globally accepted metrics. This will be a start and some of these analyses might not work in India but this can be further refined in future. Hospitals already collect tons of data elements on paper and digitally, including patient data, billing information, disease characteristics so on and so forth. Several hospitals have also adopted some sort of electronic health records but it is disjointed even within the hospitals. The first step, thus, would mean a detailed data mapping exercise. It sounds like a tedious exercise but will be essential for the next steps to come.

Once such a data architecture project is on the go, the use of latest data processing and visualisation techniques can come in handy. Use and publication of such metrics can then be used as a differentiating factor in the already crowded hospital scene, esp in urban and semi-urban set-ups. It will not only help patients get the quality of services they need, but hospitals in turn will gain brand recognition and customer loyalty.

If this data is so readily available, has there been already some work done in India? Yes, there are indeed research publications and presentations by many private sector hospitals as well as some public hospitals on some of this data. However this is quite fragmented, restricted to certain years and not continuous. Moreover, this data is collected for research purposes and hence its not clear how hospitals are utilizing this for their service quality.

A lot is being discussed and debated about the Indian healthcare system but one of the key aspect missing currently is accountability from healthcare service providers. As hospitals continue to gain centre stage in the ecosystem, developing and utilizing service metrics will be a smart business advantage.

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