A Turnaround Tale

Dr Kishor Pujari, CEO, Geetanjali Medical College and Hospital, speaks on strategies that led to making it a self- sustainable hospital

By Rita Dutta

Udaipur, the city of lakes, is one the most-sought after tourist destinations with over 10 lakh tourists visiting it annually from across the globe. The erstwhile capital of Mewar has been witnessing a boom in healthcare in the last few years with a spurt in private hospitals like Pacific Medical College Hospital, The Ananta Institute of Medical Sciences & Research Centre, Geetanjali Medical College and Hospital, GBH American Hospital and the entry of a mega corporate brand with Fortis Healthcare’s tie-up with the JK Group.
The spate of institutes, offering world class facilities, excellent clinical acumen and cutting edge technology, has been partially successful in arresting the trend of outflow of patients to Ahmedabad. Whether it was cardio, neuro or oncology or joint replacement, the affording class in Udaipur had preferred to trudge to Ahmedabad or sought treatment in the nursing homes that dot the city’s medical landscape. A decade back, the non affording class opted for treatment in the Government-run Rabindra Nath Tagore Medical College.
With a renaissance in healthcare of sorts in the last few years in Udaipur, the city has now become an over saturated market in terms of having a bed strength of over 9,000 for a population of around 4.5 lakh in the city and another 5 lakh in the periphery. Says Akhil Dave, GM – Marketing, GMCH, “Of the 9,000 beds, around 5,000 beds are in the six medical college hospitals.” Besides the Government-run Rabindra Nath Tagore Medical College, the five private medical college hospitals are Pacific Medical College, American International Institute of Medical Sciences, The Ananta Institute of Medical Sciences & Research Centre, Pacific Institute of Medical Sciences and Geetanjali Medical College.
With around 67% of the populace in Rajasthan covered under Bhamashah Swasthya Bima Yojana, a state health scheme to provide cashless facility to the IPD patients, the non affording class now gets free treatments at the affiliated centres of the scheme. And several doctors, with specilisations from AIIMS, PGI, Tata Memorial, JIPMER and other premier institutes, with roots in Udaipur have returned to the city- creating a superior and abundant clinical talent pool.
While some of the medical colleges have been plagued with financial crisis and other regulation related bottlenecks, one institute that is making rapid strides is Geetanjali Medical College and Hospital (GMCH). This 1,150-bed super specialty tertiary care hospital is spread over a sprawling 35 acre campus and is nestled amidst the majestic Aravali range.
A part of Geentanjali University, GMCH has been the dream of JP Agarwal- a leader with business interests in marble and granites. GMCH is a recognised medical college by the Medical Council of India with annual intake of 150 MBBS students and 105 PG seats and two DM neurology seats. According to Ankit Agarwal, son of JP Agarwal and Executive Director, GMCH, “We started our engineering college under the banner of Geetanjali Institute of Technical Studies in 2002. And then established GMCH in 2008, with an investment of around Rs 100 crore.”
The family forayed into healthcare with an endevaour to provide quality medical care to the society at an affordable rate. “Somewhere in year 2003, when my grandmother was paralysed due to a brain stroke, we had to take her all the way to Mumbai and Jaipur for regular treatment. Realising the inconvenience of people from this city, my father dreamt of building a world class medical facility to fulfill the medical needs of the society,” says Ankit.
Despite such grand infrastructure and cutting edge technology, the hospital was not self sustainable till 2016. This was mainly due to low occupancy rate and OPD footfall, as well as revenue leakage and lack of benchmarked services. For GMCH, 50% of its patient profile is covered under the Bhamashah, and another 25% under various corporate and TPAs. The cash paying patient is only 25%.

The turnaround process
When Dr Kishor Pujari took charge as CEO of GMCH in July 2016, he was tasked with the mandate of turning around the hospital, as well as establishing an institute with highest clinical standards. Equipped with his versatile hospital management experience during various assignments in India and overseas in the past, he chalked out strategies for revenue upscaling, cost optimisation and building a roadmap for high quality clinical care. He actioned trimming down cost of operations, plugging revenue leakages and improving operations with an eye on boosting the revenue.
Firstly, the group looked at curtailing manpower cost. “We analysed our resources and split it into three categories- absolutely required, required and not required.” The list included doctors, nurses, ward boys, administrative and housekeeping staff. The group knocked off the ‘not required category’ and thus shrunk the 2,400 strong workforce by around 9% and this reduced the manpower cost by around 7%.
Secondly, the management looked at decongesting certain departments. “We realised that many patients, discouraged by long queues in registration desks, diagnostics and pharmacy, often sought those facilities outside,” says Dr Pujari. GMCH streamlined patient management in diagnostics area by introducing the token management system. And it opened three more pharmacies, ensuring one pharmacy on each of the six floors, to curtail the long waiting time and ensuring comfort and convenience for the patients. Thirdly, the group looked at reducing the cost of consumables by renegotiating better rates with the vendors. In laboratory services, it renegotiated all previous rental contracts for lower and better rates. Fourthly, it plugged several areas of revenue leakages and stopped pilferages. “We took appropriate steps to stop revenue loss at the emergency entrance, which had become a den for agents to woo away patients to different hospitals,” says Dr Pujari.
An infirm materials management system often led to pilferages and wastage of valuable resources. The management created a robust material management system and made it mandatory for all consumables, medicine, equipment and general category products to be entered in the system before they were allowed to enter, consume at various service areas or exit the hospital gate. Fifthly, to ensure more paying patients chose GMCH and don’t feel uncomfortable seated beside the non-paying poor patients, the hospital created a separate and modern block for the paying class- with OP and IP facilities. It also founded a corporate management wing to look after these patients. In the pipeline are 48 super luxury rooms for better experience to the paying class patients.
Sixthly, to ensure highest quality of clinical care, GMCH took many clinical excellence initiatives. The hospital laid down the processes and protocols to standardise care delivery at every patient touch points, from entry to exit and created a list of key quality indicators to monitor the clinical processes and outcomes. Periodic reports helped the management to strategise further to enhance clinical excellence in all areas.
Lastly, the management revised the tariff of multiple services and focused more on the revenue drivers- the super-specialty services like cardiac sciences, oncology, onco-surgery radiation, neuro-sciences, nephro-urology, IVF and others and aligned various marketing activities. “These efforts have led to OPD footfall shoot up to around 1,100 per day and bed occupancy to go upto around 800. We have also witnessed a swell in revenue by 35%, as compared to 2016,” says Dr Pujari.

Another feather in its cap
Besides being a pioneer in many areas, GMCH in March 2018 received the full accreditation (4th Edition) by National Accreditation Board for Hospitals and Healthcare Providers (NABH), the highest national recognition and a mark of quality patient care and safety.
This made GMCH the first medical college and large teaching hospital to be NABH accredited in the state of Rajasthan. “Among 550 full NABH accredited hospitals, only five medical colleges have this recognition and now GMCH is one of them,” said Dr Pujari.

In the pipeline
In the immediate future, the group is slated to start a kidney transplant programme. In July, GMCH received the approval for kidney transplant, making it the first in Southern Rajasthan to receive the permission.
Always in the forefront of technology, GMCH is installing second high-end cathlab, one 3T MRI and 120 Slice CT. The institute does more than 300 cath lab procedures, 85 Cardiac (adult and pediatric) Surgeries per month. And how do the promoters see the group, a few years down the line? “As a medical hub not only for Rajasthan but for large parts of MP and Gujarat as well. We want GMCH to be perceived as a Centre of Excellence with top notch doctors and cutting edge technology and one that is on par with leading corporate hospitals, but offering high quality healthcare services at a subsidised rates,” says Dr Pujari.
The group has acquired land in the Jaipur Ajmer Road for starting a second medical college and hospital. “But the plans are on hold due to various reasons,” said Ankit. The group is looking at forging tie-ups with some international universities for research and training. GMCH is all set to put Udaipur in the medical tourism map as well. “With Udaipur being a favourite destination amongst international tourists, we want to tap international patients from the Middle East and African countries to begin with, for medical tourism,” said Dr Pujari.
GMCH is a case study of how a large teaching hospital can also compete with corporate hospitals in clinical outcomes, service and cutting edge technology.

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