Redesigning hospitals

While hopsitals can be very comforting, the biggest complaint patients have about hospitals is the fact that they are impersonal and bureaucratic.

I feel the best way of working around this problem is by allowing doctors to run the hospital. Today, hospitals are run by administrators, who are often only interested in the "bottom-line". Doctors, on the other hand, understand how important it is for them to keep their patients happy !

The best model would be a co-operative hospital, which is run by managers, but where the doctors are owners. Doctors could be treated as the shop-owners in a mall - the hospital would lease them consulting room space; as well as provide their patients with in-patient rooms, nursing care and theatre and lab facilities, for which they would be charged, but the ownership of the patient ( customer) would reside with the doctor.

Traditionally, most hospitals were started as small facilities, by individual doctors, to serve the needs of their own patients. This was a very successful model, because it allowed the doctor to provide his patients with personalised care very inexpensively, beause there were few overheads. However, as medical technology started growing by leaps and bounds, the capital equipment costs, space and infrastructure needed for taking care of seriously ill patients became so humoungous that these needs could only be met by large hospitals, which were very expensive to setup.

This is where governments, and then universities stepped in. While the purpose of government hospitals was to provide care to their citizens; and the goal of university hospitals was to further medical research and to train medical students and residents, corporates got on to the bandwagon and started setting up hospitals to earn profits.

We need to reinvent the hospital, and we can learn a lot from the hospitality industry, which offers tourists a wide range of options - all the way from inexpensive "bed and breakfast " accomodation to luxury upmarket 5 star hotels. It's a good idea to offer the patient a choice - and often for simple procedures ( such as childbirth and elective surgery), a simple basic hospital is far more cost effective.

This is why custom designed "day care surgery units" have done so well in the US. Why can't we extend the model and use it to manage simple medical problems which require hospitalisation ? We could have Level I hospitals, which would take care of the "bread and butter" basic problems; and the Level II hospitals, which would take care only of the seriously ill patients with complex problems. This would be a much more effective use of limited resources, and help to keep costs down !

This has been successfully done in India for many years; and an excellent example is the 100-bed Shusrusha hospital in Bombay, which provides very high quality medical care very inexpensively. Unfortunately, the current craze is to ape the West, and everyone is competing to build 5-star deluxe corporate hospitals , which cost the earth, and are prohibitively expensive !