The Aga Khan University

Hospital

History and Introduction to Hospital:

The word "hospital" comes from the Latin "hospes" which refers to
either a visitor or the host who receives the visitor. From "hospes"
came the Latin "hospitalia", an apartment for strangers or guests, and
the Medieval Latin "hospitale" and the Old French "hospital." It crossed
the Channel in the 14th century and in England began a shift in the
15th century to mean a home for the elderly or infirm or a home for
the down-and-out. Hospital is an institution or the organization for the
treatment, care, and cures of the sick and wounded, for the study of
disease, and for the training of physicians (teaching hospitals), nurses,
and allied health care personnel.

What is the importance of Hospital Management?

The answer to this question is simply that supervisors and managers of

hospitals must not only have vocational, technical knowledge about
hospitals and treatment, but also should have three types of
knowledge, about contemporary management and its functions and
principles. The work module of any job is based on two pillars, namely
technical work and management work.

What is to be managed in Hospital?

Like other organizations and institution, hospitals or any healthcare
facility passes through the following stages or in other words they need
the management of below sections for the smooth running of their
organizations, but the hospitals are very complex in its nature.

• Operations (actions)
• Finance (money and resources),
• Personnel (human relations)
• Information (needed information for wise decisions)
• Time (you’re own and that of others)

According to the Project Definition: “A project is a sequence, set or

series of unique, complex and connected activities, having one goal or
purpose to be completed with time frame, allocated budget and
according to its specification, now we can say the leading, controlling,
organizing and planning of all these activities is called project
management. Now we can say it easily, that a hospital or any
healthcare facility is a project in its nature, therefore; applying the rule
of project management will be no far away from it.
Each of these five elements mentioned, must be managed by any
person, who has its own set of principles and guidelines to follow. For
instance, when it comes to managing people, the teachings of
Industrial Psychology become pertinent. For operations, the teachings
of Operations Management as a subject become important. So, in
analyzing these five elements, it also becomes evident that the
teachings of Financial Management, Information Management and
Time Management, are also important for the other three elements.
Concisely, for a hospital manager it is compulsory to have the sound
knowledge of Operations Management, Financial Management,
Information Management, Human Resources Management, Time
Management and Communication. For the lower level jobs at hospitals
and healthcare facilities, the principles of Supervision can become a
starting point for teaching or studying the principles of management. A
person in one of the lowest level jobs found at employers must also
plan, organize and control work, even if it is just to clean an office or
do some washing in one of the departments of the hospital. Top
Management members of the hospitals such as Chief Executive Officer,
Financial Manager etc, must be able to plan, organize, control and lead
the wards and departments with a focus on understanding and
influencing the environment, setting the strategy and gaining
commitment, planning, implementing and monitoring strategies and
evaluating and improving fitness. The Top Management must therefore
have high capabilities with regard to human relations inwards and
outwards, strategic planning, team building, leadership, and
negotiation and fitness management. Middle Management members
must be able to plan, organize, control and lead departments and
sections with a focus on assistance upwards for application of scientific
methods and assistance downwards for application of scientific
methods. They must have the same capabilities as Senior Managers as
well as Supervisory Managers and also be good at interviewing
techniques, goal achievement, conflict handling tactics and project
management. supervisory Management members must also be able to
plan, organize, control and lead sections, units and individuals with a
focus on operations, finance, people, information and time. Lack of
Management skills in employer or employees at every hierarchy level
of the hospital or healthcare facility can be detrimental. Lack of
Management skills can lead to poor fitness, lack of improvement, low
profit, decisions making, disheartening of employees, lower
productivity, and jeopardize your organization. Therefore, it is
obligatory that hospital managers should have the updated and
cotemporary knowledge of Management. In below sections, you will
read more about hospital management, that how to manage hospitals
or any healthcare facility in order to achieve the intended objectives to
meet the organizational goals.

Concept of Productivity in the context of hospital:

As we are discussing regarding the concept of Productivity in the

context of a hospital, so we must know that every organization
whether it is Profitable or non-profitable, governmental or non-
governmental needs and uses different resources, which is classified in
many groups:
• Manpower/Labor/Task Force
• Material/ Raw Material
• Money/Cash/Budget
• Machinery/Equipment

The effective and appropriate usage and utilization of the above-

mentioned factors or resources shows and determines the
organization’s effectiveness. For example if it is a profitable
organization, its benefits and advantages are increased, while in case
of other organizations, its costs are reduced and diminished, therefore
the reliance on private sectors and donors or government grants and
aids or itself the fee for its services are diminished.
The effective and valuable usage/utilization/consumption of the
resources or assets is important and significant for every organization
or association, whether it is public or private. Hospitals are not
including in the row of except ness, they should be included. Actually,
Health care organizations or hospitals need to give more and more
concentration and attentiveness to good and better management and
execution because of the shortage of resources. Usually the health
related organizations are short of resources, bearing in mind the
demands for services placed onthem.5It is useful at this phase to
comprise how management and productivity concepts as well as
techniques are related to the health field. There is mistaken idea that
modern management and productivity concepts and techniques are
concerns to profit- making institutions and manufacturing
organizations only.
Productivity or Output, in simplest terms, is the relationship or bond
between the resources used and results produced. In shorter terms the
productivity is the ratio or difference between Input and output.

Input + Output=Productivity.

The effective usage of inputs will ultimately increase or affect the

output or productivity. So it means that we must give more
concentration for the effective usage of inputs or resources, we must
allocate all our resources in a better way in order to achieve our goals
and objectives. So for the improvement and enhancement of the
productivity it is so important to have qualified and well trained and
skilled staff, by this way they utilize and use the resources and raw
material in good manner. This is the responsibility of the organization
to conduct seminars, workshops and trainings for their employees.

Equipment:

As it is obvious and more apparent that most hospital or health

facilities have expensive equipment remains out of the order or
inventory list because of the insufficiency of the engineering
department, improper maintenance, defective service contracts and so
on. The expensive and costly equipment is under utilized because
often the users do no have a clear understanding of the capital cost of
the equipment or machinery and the bond between these costs,
capacity utilization and a fee charged from the patients. It is important
to improve and enhance the quality of medical services without
incensement in fees and other charges. And it is also possible to
increase the quality of services without increasing the fee by improving
the utilization and usage of the existing equipments and machinery.
Thus the engineering department of the hospital or health facility is the
most and critical department, because they are mostly involved in the
maintenance and repairing the equipments and machinery, as it is
usual in my hospital there is no proper system of the maintenance. A
planned and scheduled maintenance can reduce the chance of
breakdown and damage in of machinery and
Deterioration in normal routine hospital activities. All the staff of the
hospital must be understand about the usage and operation of
electrical/mechanical appliances and equipments. By this way, we can
prevent the breakdown the equipment.
Personnel Matters:

Almost all the staff who is working in the engineering department they
are not satisfied from their works due to their small salaries, wage of
disparities and lack of opportunities for development and so on. It is a
clear fact that the engineering department is so neglected, so they
hospital management should in take all these concerns regarding the
engineering department, their problems should be solved in a better
way for the betterment of hospital services.

Space:

Space is also playing a dominant role in the productivity of hospitals,

as we have seen some of the hospital have so small space while other
has a plenty of space. Example of the poor use of space, and defective
layouts of equipment causing unnecessary movements of personnel
and hospital staff, patients and materials. For the better planning of
hospitals we need a coordinated thinking of medical specialists,
engineers and architects specializing in the hospital field.

Funds:

In most hospitals and health facilities the financial and costing system
are usually weak. The particular income or surpluses and the expenses
of various departments are not separately analyzed nor the different
costs fixed. As a result the related medical and other staff has no idea
and concept of the financial management and its implications of the
resources at their disposal, or the relationship between costs and the
fees for various resources. It is obvious that financial management
becomes very critical to the productivity of hospitals. Public hospitals
in general need a financial advisor who can advise the management on
its spending policies; this will help cost reduction which is so vital.
Many of the health related institutions suffer from the unfavorable and
unpleasant ratio of administrative and actual healthcare expenditure.

Material:

It is clear fact that the good material management can be use to

diminish operating costs for the time it is somehow been neglected in
hospitals and other facilities, so it is most important to take
inconsideration the vitality of the material management in order to
achieve the goals and objectives of the hospital. As it is indicated in
previous surveys, that 40 to 50 percent of the annual budget of the
hospital are spending on material used.

Hospitals must adapt the ways and methods to streamline and make
more efficient their procurement, consumption and utilization control,
inventory and records control, storage and dissemination and service
organization.

The following factors have a big role in the effectiveness of

materials

• The items that are needed urgently should be provided.

• Use the money in such a way that the cost of storage is reduced to a
minimum.
• Handle the items and equipments with the least loss in storage and
management.

In order to achieve the above mentioned objectives when need to have

a good and stabilized policy decisions. However we have to put the
short term polices for the time being to run our work.

Personnel:

As it is a clear fact and I mean it is obvious to all of us that hospital

totally and almost always on human resources/Man Power, the
numbers of human resources usually higher than in other
organizations. So in a result the quality of the services in hospital
totally depends on the quality of their human resources and man
power. So for that the management is very crucial in this stage.
Actually, the staff or personnel productivity (output) is quite low in
many hospitals. It is a big problem that the staff is not assigning in a
specific hours of work but not with wholehearted commitment. So they
show insufficient commitment to their tasks, to the care for the
patients, and towards creativity in finding solutions to institutional
problems. Regarding the capacity, building and training of the staff and
personnel hospitals infrequently sponsor staff and personnel to
external training program. But in large hospitals the training can take
place in house with the help of professionals organizations, so these
trainings should be conducted periodically so that the employees and
staff make aware from the new changes in technology and techniques.
It is so vital for the hospitals to train their staff qualitatively and
quantitatively. The trainings by up gradation of staff and personnel
skills can help in the improvement of staff productivity.

INTRODUCTION

The Aga Khan University Hospital, Karachi (AKUH) was established in

1985 as the primary teaching site of the Aga Khan University’s (AKU)
Faculty of Health Sciences. Founded by His Highness the Aga Khan, the
hospital provides a broad range of secondary and tertiary care,
including diagnosis of disease and team management of patient care.
The hospital’s multidisciplinary approach to diagnosis and care ensures
a continuum of safe and high quality care for patients - with all
services under one roof.

The hospital promotes the Aga Khan University's objective of

promoting human welfare in general, and the welfare of the people of
Pakistan in particular, by disseminating knowledge and providing
instruction, training, research, and service in the health sciences. Aga
Khan University is Pakistan's largest private medical institute and
hospital

The Hospital is part of the Aga Khan University (AKU) in Karachi,

Pakistan. Chartered as the country’s first private international
university in 1983, AKU’s objective is to promote human welfare by
disseminating knowledge and providing instruction, training, research
and services in health sciences, education and other disciplines. AKU is
a non-denominational institution open to all on merit, and admissions
to its academic programmers are needs blind. The University places
special emphasis on the development of women. Through its high
academic standards, programmers relevant to the needs of developing
societies, its work as a dialogue partner with government on issues of
health and education policy, and its delivery of critical social services,
AKU has had a national impact in Pakistan.

With the launch of academic programmers in East Africa, the United

Kingdom, Syria and Afghanistan, AKU has now established itself as an
international institution at ten sites in seven countries. AKU’s Faculty of
Health Sciences, comprising a Medical College and a School of Nursing,
is located on the same campus in Karachi as Aga Khan University
Hospital (AKUH). The Institute for Educational Development (AKUIED) is
situated at another campus in Karachi, while the Institute for the Study
of Muslim Civilizations (AKU-ISMC) is based in London. With the
development of AKU-IED and AKU-ISMC, along with the planning of a
Faculty of Arts and Sciences, AKU has moved towards becoming a
comprehensive university.

Aga Khan Health Services

The Hospital and primary medical centers are part of the Aga Khan
Health Services, which is one of the most comprehensive private not-
for-profit health care systems in the developing world. It includes 325
health centers, dispensaries, hospitals, diagnostic centers and
community health outlets. Building on the Ismailia Community's health
care efforts in the first half of the 20th century, Aga Khan Hospital
Services (AKHS) now provides primary health care and curative
medical care in India, Pakistan, Kenya, Tanzania, and Syria. It includes
5 general hospitals, 7 maternity homes/hospitals and 187 health
centers/dispensaries. The first institution in the Aga Khan Health
Service, Pakistan (AKHS, P) was a 42-bed maternity hospital - formerly
known as the Janbai Maternity Home, which opened in Karachi in 1924.
Today, while maintaining that early focus on maternal and child health,
AKHS, P also offers services that range from primary health care to
diagnostic services and curative care. Its 164 health centers, seven
hospitals, maternity home, two medical centers, physiotherapy unit
and seven community dental units reach over 581,000 people in rural
and urban Sindh, Punjab and Frontier, Northern Areas and Chitral. As
the largest not-for-profit private health care system in Pakistan, its goal
is to supplement the Government's efforts in health care provision,
especially in the areas of maternal and child health and primary health
care.

Aga Khan Health Service, Pakistan also operates six diagnostic centers
with the consultant services and laboratory facilities in different parts
of Pakistan. AKHS, P manages over 1000 employees, around 4000
dedicated volunteers, over 1500 Trained Birth Attendants (TBAs) and
Community Health Workers (CHWs) working in different regions of
AKHS, P.

Healthcare Activities of the Aga Khan Development

Network

AKHS activities are conducted in concert with other health-related

activities of the Aga Khan Development Network (AKDN). The overall
aim is to raise the health status of people in East Africa and elsewhere
in the developing world. Emphasis, in current projects, is on
strengthening health systems development.
The Aga Khan Foundation (AKF), with branches in Kenya, Tanzania, and
Uganda, works with a variety of grantees, including AKHS, to improve
the health of vulnerable population groups, especially mothers and
children, and promote health services development on the national
and regional levels.

AKF and AKHS have been joined in their work in health care in East
Africa by the Aga Khan University's Faculty of Health Sciences, which
offers accredited professional training, especially for nurses, and
conducts a variety of research programs focused on the health
problems of developing nations. The AKDN aims to assist countries in
the building of effective, sustainable health systems linking different
kinds of services and levels of care.
SERVICES OF AGA KHAN HOSPITAL AND UNIVERSITY:

Aga khan hospital is one of the biggest hospitals of Pakistan, offering

several kinds of services. These services include:

LABORATORY SERVICES:

Clinical laboratories provide a complete array of routine and

specialized services. The services are related to all six branches of
laboratory/pathology including hematology, blood bank, clinical
chemistry, clinical microbiology, histopathology, cytopathology and
molecular pathology. Over 800 routine and specialized tests such as
general biochemical profiles, enzyme profiles, endocrine assays,
karyotyping, flow cytometry and HLA typing are available along with
several other special tests, which are not available elsewhere in
Pakistan.

Laboratory testing is also provided for the diagnosis and management

of hematological disorders such as anemia and thrombolytic disorders.
Diagnostic microbiological services include the determination and
identification of bacteria, fungi, viruses and parasites. Serologic tests
are also available for various bacterial, viral, fungal and protozoa
diseases. Histopathological and cytopathological services have all the
specialized procedures and techniques, such as immunoperoxidase,
immunofluorescence, muscle enzymes, histochemical and flow
cytometry techniques to enhance diagnostic accuracy. Services for fine
needle aspiration and pap smear are also available. A team of full-time
consultants and technologists with extensive training and experience is
committed to keeping the clinical laboratory at the cutting edge of
technology.
Laboratory services are provided through a well-equipped, highly
automated and professionally run facility, providing 24-hour service
seven days a week, including holidays, by a team of full-time
histopathologists, hematologists, chemical pathologists, molecular
pathologists and microbiologists. The services offer routine and special
clinical chemistry, hematology, blood transfusion, microbiology,
immunology, surgical pathology, cytology and molecular pathology.

Specialized sections of the laboratory include Endocrine Laboratory,

Cytogenetic, Fluorescence In Situ Hybridization (FISH) including
Pathvysion and Aneuvysion, Aspiration Cytology including Fine Needle
Aspiration (FNA), Frozen Sections, Therapeutic Drug Monitoring and
Molecular Pathology. Accuracy and precision of tests are maintained by
strict internal and external quality control procedures.

AKUH's clinical laboratory participates in various quality assurance

programs and is well known for its accuracy and precision of testing.
To date, the Hospital has a network of approximately 200 laboratory
specimen collection units in all major cities of Pakistan and performs
over 7 million tests annually. AKUH also receives pathological
specimens from UAE.

The Department of Pathology and Microbiology serves the clinical

laboratory network of the Hospital. The laboratory is one of the first
laboratories in the world to receive ISO Certification and Joint
Commission International Accreditation (JCIA). The Department also
publishes a regular pathology newsletter that provides an update on
new procedures and tests in the clinical laboratories.

Cardiopulmonary Diagnostic Services

The Cardiopulmonary Diagnostic Services at Aga Khan University
Hospital is the largest diagnostic centre of its kind in the region. Since
1985, the Non-invasive Cardiopulmonary services has expanded and
evolved into a very sophisticated laboratory, providing the latest
diagnostic facilities in the evaluation of adult and pediatric patients
with heart and lung diseases.

The laboratory’s core is the Echocardiography section and is staffed

with highly competent technologists and cardiac fellows on rotation.
There are four sophisticated color Doppler echocardiography
machines. Over 6,000 examinations are performed annually to
evaluate the structure and function of the heart muscles and valves in
detail, minimizing the need for invasive testing. Eight different echo
modalities are performed: (i) Adult Tran thoracic (ii) Transoesophageal
(iii) Dobutamine Stress (iv) Contrast (v) Fontal (vi) Pediatric (vii)
Interventional and (viii) Intraoperative.

The major aim of the Cardiopulmonary Lab is accuracy of results with

promptness of service.

Services

The Cardiopulmonary Diagnostic Laboratory is located on the ground

floor of the Nazerali-Walji Building and consists of the following five
sections:

I) Pulmonary Function Test (PFT)

The PFT laboratory offers services for:

1. Spirometry
2. Bronchodilator Reversibility
 3. Lung Volumes and Transfer Factor (these tests provide a
comprehensive assessment of diseases of the lungs and airways)
4. MIP/MEP (Maximal Inspiratory/Expiratory Pressures), to measure
muscle strength
5. Pulmonary Rehabilitation Programme

In addition, facilities for Pulse Oximetry and the six-minute Walk Test
are also available.

II) Diagnostic ECG

Services offered include:

1. Resting Electrocardiograms (ECG)

2. Stress/Exercise Tolerance Testing (ETT)
3. Ambulatory Blood Pressure Monitoring (ABP)

III) Arrhythmia Evaluation

Services offered include:

1. AmbulatoryECG(Holter)Monitoring

A Holter monitor is a 24-hour portable electrocardiogram monitor

for the detection of heart rhythm problems, ischemia or frequent
unexplained episodes of palpitation or syncope.

2. Head-upTiltTest(HUT)

This is a tool for the work-up of syncope. Currently, we are the

only institution offering this test in Karachi. For neurocardiogenic
syncope (vasovagal), this remains the gold standard of diagnosis.
 3. PacemakerFollow-upCheck
Aga khan hospital also offer a pacemaker clinic under the
supervision of Board Certified Heart Rhythm Specialists. This is a
unique service for patients with permanent pacemakers and ICDs
in place. For such patients, regular check-ups are important to
ensure a smooth and trouble-free service. This service is also
offered to patients who had pacemakers implanted at other
hospitals.

IV) Echocardiography

Services offered are:

1. AdultEchocardiogram

Echos are performed on state-of-the-art equipment by highly

trained technologists and reported by experienced cardiologists.
Echo provides structural and functional information of the heart:
i.e. systolic and diastolic function of the ventricles, morphology
and function of the valves, etc. Echo is therefore mandatory for
patients with heart failure and suspected valvular and congenital
heart disease.

2. PaediatricEchocardiogram

Paediatric studies are performed by paediatric cardiologists.

3. FoetalEchocardiogram

Echo is performed during pregnancy to assess any congenital

abnormalities in the foetus in high-risk patients. Early diagnosis
and treatment of these abnormalities may be life-saving. This
test requires highly-skilled paediatric cardiologists, technologists
 and state-of-the-art equipment which are available in our
laboratory.

4. Trans-oesophageal-Echocardiogram(TEE)

TEE provides excellent cardiac images and can be used to

visualise left atrial appendage, inter-atrial septum thoracic aorta,
metallic prosthetic valves, small vegetations and complications
of endocarditis. These are indicated in patients with sub-optimal
images of transthoracic echo, suspected ASD, endocarditis,
dissection of aorta, assessment of cardiac source of embolus and
metallic prosthesis, etc.

5. StressEchocardiogram

Stress echocardiogram is a valuable tool in the assessment of

coronary artery disease and the viability of damaged heart
muscles. Its results are equivalent to information obtained from
thallium scan. If the patients can exercise, Treadmill Stress Echo
(TSE) is performed which also provides information on functional
capacity. If the patient cannot exercise or a myocardial viability
assessment is required, then Dobutamine Stress Echo (DSE) is
performed. Stress echo is a safe test in stable patients.

V) Nuclear Cardiology

Nuclear cardiology has established its unparalleled role in helping both

diagnose and prognosticate patients with heart disease. Nuclear
cardiology is a special type of X-ray procedure that uses very small
amounts of radioactive material to diagnose heart disease. Nuclear
cardiology procedure is safe, and the amount of radiation exposure is
no greater than a common chest X-ray. It is highly effective in
determining the degree of blood flow to the heart muscle and in
detecting the presence of arterial blockages in the heart. In addition,
this test also helps a doctor to decide the extent of risk and the best
way of treatment. Imaging is performed on a state-of-the-art dual-head
gamma camera which is designed to meet the high-throughput and
high-quality demands of the most progressive cardiology practices. A
nuclear cardiology test usually consists of taking two sets of pictures of
the heart; one following stress (via exercise or injection), and the other
during a resting phase. The patient receives one or two injections of
radioactive material at different time intervals. The entire test takes
about five to six hours.

We offer the following studies:

1. Exercise treadmill myocardial perfusion imaging using Thallium

201
2. Exercise treadmill myocardial perfusion imaging using
Tetrofosmin
3. Dipyridamole (Persantin) myocardial perfusion imaging using
Thallium 201
4. Dipyridamole (Persantin) myocardial perfusion imaging using
Tetrofosmin
5. Dobutamine myocardial perfusion imaging using Thallium 201
6. Dobutamine myocardial perfusion imaging using Tetrofosmin
7. Resting myocardial perfusion imaging studies for chest pain
evaluation
8. Dual isotope studies
9. Gated imaging studies to estimate left ventricular function. This
unique service enables determination of blood flow to the heart
as well as cardiac function in one test

VI) Off-site Non-invasive Services

Transthoracic Echocardiogram, Holter monitoring, Ambulatory BP
monitoring and ECG services ate also offered at Clifton Medical
Services.

All specialised tests are conducted under direct supervision of highly

trained cardiologists, pulmonologists, and a team of skilled technicians.
Except for the ECG, all specialised tests require prior appointment.

Home Physiotherapy Services

To increase convenience and accessibility for its

patients, Aga Khan University Hospital (AKUH) offers
Home Physiotherapy Services. Now you can save time
and inconvenience of traveling by utilising the same
high-quality service available at the Hospital in the
comfort of your home. The service is available in almost
all areas of Karachi . To avail services, please call our
Coordinator for Home Physiotherapy Services at Tel:
+92 21 3486 1531 and 3486 1532 or 3493 0051 Ext. 1531/1532
(Monday to Saturday).

Home Health Nursing Care Services

AKUH offers skilled, trained and dependable professional nursing staff
through the Home Health Nursing Care program. The services can be
availed on an hourly or daily
basis.

Inpatient Services

AKUH provides comprehensive

inpatient services in almost all
major disciplines of medicine
and surgery. There are 15
inpatient units with a total capacity of 563 beds . This includes 55 c
critical care beds of ICU, CICU, CCU and NICU. The average length of
inpatient stay at AKUH is the lowest in the city; i.e. 3.4 days . All
inpatients are routed through either the Emergency Medicine Section
or the outpatient services.

Facilities offered in nursing units are: five-bedded general wards, two-

bedded semi-private rooms and single-bedded private rooms and
limited VIP private rooms in the Private Wing. Most of the nursing units
have a five-bedded Special Care Unit (SCU) for patients who need close
monitoring and supervision. The major strength of the inpatient service
lies in its highly dedicated team of professionals comprising medical
consultants, fellows, residents, trained and competent nurses and
other paramedical staff who provide high-quality health care through a
collaborative effort together with a broad range of state-of-the-art
equipment to give the best possible diagnosis and treatment options.
Being a teaching Hospital affiliated with Aga Khan University's Faculty
of Health Sciences, the clinical ward rounds are typically medical
education oriented. Senior residents are available to patients round-
the-clock.
All inpatient services have a unique system of prescribing drugs
through Physician Order Entry (POE). Each floor has a operational
nursing station equipped with network computer systems for accessing
a patient's investigation results and medical records, unit receptionists,
nursing staff and residents.

Urgent Care Services (UCS)

• UCS provide treatment for a condition that requires prompt

attention but does not pose an immediate, serious health threat.
• Ear infections and sprained ankles are examples of conditions
that Urgent Care staff can treat.
• The service caters to medical problems that are not emergencies
but need to be seen the same day.
• Patients with critical, serious or life-threatening illnesses/injuries
will be transferred to the emergency of AKUH at Stadium Road in
a fully equipped ambulance staffed by a physician.

Pharmacy

Pharmacy services are operated under the supervision of graduate

pharmacists who provide complete information related to drugs and
their usage. All drugs are stored at a controlled temperature to
maintain their validity and efficacy. Pharmacy services have the facility
to prepare special drug formulations for patients if requested by their
doctors.

Radiology

Radiology services (general radiography, orthopentomogram (OPG)

and ultrasound with color Doppler, small parts and endo-cavitory
probes) are provided under the supervision of qualified radiologists. In
case of special procedures, such as MRI, CT and Nuclear Medicine, our
staff would provide assistance in taking appointments from AKUH's
main radiology facility on the Stadium Road campus.

Cardiopulmonary Diagnostic Services

Accurate and reliable cardiopulmonary diagnostic services are

extremely important for early
diagnosis of heart diseases.
Diagnostic services include
Electrocardiography (ECG),
Echocardiogram
(transthoracic), Holter
monitoring and Ambulatory
Blood Pressure monitoring. Procedures/ tests are performed reported
by credentialed cardiologists.

Physiotherapy Services

Physiotherapy services are available for

Orthopedic, Rheumatic, Neurological and
Pediatrics conditions by skilled
Physiotherapists. Physiotherapy Services
also provides services for rehabilitation of
traumatic and sports related injuries.

Hospital Services
Whether you want to offer your employees hospitalization coverage,
laboratory testing, vaccination, annual health screening, pre-
employment screening, drug testing or you need a regular physician at
your Hospital site, Aga Khan University Hospital (AKUH), Karachi has
the expertise to address all your Hospital health care needs. Top cadre
local and multinational corporations in almost all industries utilize our
Hospital health services. AKUH, Karachi is also the first choice for
foreign consulates and foreign companies recruiting from Pakistan.
Utilize our twenty years of experience in providing Hospital health
services to discover a high quality, cost-effective health care option for
your employees.

• Hospital Registration Process

• Pre-employment Screening Services
• Vaccination Services
• Executive Clinic Services
• Hospital Health Awareness Programs
• Hospital Patient Business Services Department

Hospital Registration Process

As part of the Hospital registration process, our Hospital clients are

requested to sign a Memorandum of Understanding (MOU), which
outlines the roles and responsibilities of the corporation and the
Hospital. A refundable deposit is required as part of the Hospital
registration process to provide credit facility for both inpatient and
outpatient services.

The treatment at AKUH, Karachi is cost-effective due to its shorter

average length of stay of 3.6 days owing to a number of quality control
measures introduced for the first time in Pakistan, such as infection
control, peer review committees and adherence to international best
practices. Other measures such as billing of pharmacy on the basis of
consumption, that is, the patient or the employer is charged only for
the actual quantity of medicines consumed contribute towards
considerable savings in medical expenses. To date, Aga Khan Hospital
also finalizes agreements with more than 160 state owned and
multinational organizations

Pre-employment Screening Services

The practical and economic costs to your business caused by health-

related work fitness issues can be devastating. Pre-employment health
assessment enables you to identify if the applicant is fit for the specific
job, or if there are any underlying health issues which need to be
investigated.

AKUH, Karachi offers various standardized health-screening packages

and also offers the flexibility to design a health assessment package
based on the individual needs of your organization. More than 60
national and multinational companies including companies recruiting
employees for foreign countries trust AKUH, Karachi for their pre-
employment health screening needs.

Vaccination Services

Vaccination services are available for all vaccinations included in the

National Expanded Program of Immunization (EPI) as well as other
communicable diseases for which vaccination is recommended, such
as Pneumonia, Flu, Meningitis, Chickenpox, Rubella, Hepatitis A,
Hepatitis B, Typhoid, Rabies and others. Vaccination services for some
vaccines can also be availed at your Hospital site.

Executive Clinic Services

Keeping in mind the pressure at office and at home, the Executive
Clinic offers a number of time-efficient yet comprehensive check-up
programs. Details of these programs can be found in the Executive
Clinic brochure.

Hospital Health Awareness Programs

For a nation where treatment of disease is relatively expensive,

Hospital health awareness programs have proved to be an excellent
way to increase awareness of preventive health measures and early
diagnosis of health problems in employees. The Marketing Department
of AKUH assists its Hospital clients in organizing health awareness
guest lectures at both the Hospital site and at AKUH, Stadium Road.
The program consists of a presentation on a health topic by an AKUH
credentialed faculty followed by a question and answer session.
Numerous organizations have benefited from this preventive health
service.

The Emergency Department at Aga Khan University Hospital, Karachi is

visited by approximately 60,000 patients annually, of which more than
40% are admitted to the hospital. Our Department serves not only
patients from Karachi, but also receives patients from other areas of
Pakistan.

Keeping in view the increasing load on the emergency services, the

expansion plan for these services is underway. The new building of the
University Hospital Emergency Services became functional on October
22, 2008. This building is part of the expansion plan for the current
emergency services in the hospital, which is expected to be completed
by the end of 2009. After the completion of this expansion, the
Emergency Room at Aga Khan University Hospital, Karachi will consist
of 51 beds over an area of 26,700 square feet.
Our highly skilled trauma team of Emergency and Trauma Care trained
physicians and nurses provide treatment around the clock, seven days
a week. At present, the fully equipped Emergency Room is operating
with 27 beds, with a Triage Desk and Fast Track System to ensure
prompt medical attention for all patients.

The Department is organized into the following major patient care

areas:

• Triage Bay: 3-bed area for rapid initial assessment of patients

and taking decisions regarding level of care required
• Resuscitation Area: Two beds for patients with life-threatening
conditions requiring resuscitation
• Critical Care Area: 7-bed area for patients who require critical
care
• Non-Critical Care Area: 10-bed area for patients who require
'work up' by the department or other specialty teams
• Operating Area: Two beds for patients requiring minor
interventions
• Fast Track Clinics: 3-bed area for providing speedy treatment
to patients with minor illness
 Clinical Faculty

Executive Clinic

Minor fleeting complaints, seemingly insignificant, are frequently

ignored. A routine examination at the Executive Clinic provides you
with an opportunity to reassure yourself about your good health and
discuss ways to remain healthy. The major benefit of a health
evaluation program is to give information about the status of your
current health – the dos and don'ts. During the examination, potential
problems might be detected and these would be less harmful if treated
at early stages. In case a follow-up with specialists is required,
necessary appointments will be arranged, which are not included in
these packages.

To meet the growing demand for quality health care services as well as
to enhance patients experience, we are pleased to inform you that the
Executive Clinic is now located in the Nazerali Walji Building.

To suit different individual preferences, two packages have been

developed. You can select the one that
better serves your needs.

• Executive Clinic (Package A) -

Outpatient Package
• Special Executive Clinic (Package
B) - Day Care Package
• Executive Clinic (Package A) -
Clifton Medical Service
• Faculty Schedule
• Package Prices
• Timings
• Canceling / Rescheduling Appointments
• Brochure
Neurophysiology Services

Located in the main Consulting Clinic (CC) and Ward D1,

Neurophysiology Services uses state-of-the-art equipment to aid in the
diagnosis and treatment of diseases of the brain, spinal cord, nerves,
neuromuscular junctions and muscles. Well-trained and qualified
technologists perform routine procedures under the direct supervision
of consultant neurologists.

The service offers Electroencephalography (EEG), Prolonged EEG

(PEEG), Sleep deprived EEG (SDE), Sphenoid EEG, Video EEG
Monitoring (VEEG), Polysomnography (PSG), Split night
Polysomnography (SPSG), CPAP / BiPAP Titration Service, Multiple
Sleep Latency Test (MSLT), Electromyography (EMG), Nerve
Conduction Studies (NCS), Single Fibre EMG, Evoked Potential Studies
(EPS), including Brainstem Auditory Evoked Potential (BAEP), Visual
Evoked Potential (VEP), Somatosensory Evoked Potential (SSEP) and
Electroretinography (ERG).

In addition, Autonomic Testing

including Sympathetic Skin
Response (SSR) and R-R
Interval, Diaphragmatic EMG,
EMG guided Botox services,
Pelvic floor EMG and NCS and
Intraoperative SSEP Monitoring
are also performed.

Unique services like Intra-operative Monitoring (IOM),

Electrocorticography (EcorG), Tran cranial Magnetic Stimulation (TMS),
Tran cranial Doppler Studies (TCD) and Quantitative Sensory Testing
(QST) are also available. Epilepsy Monitoring Unit is the upcoming
project in 2009.

Physiotherapy and Rehabilitation Services

The Department of Physiotherapy provides comprehensive inpatient

and outpatient services to assist adults and children in overcoming
physical, neurological and cognitive impairments, disabilities and
handicaps. All Physiotherapists work with an interdisciplinary team to
restore physical functions, relieve pain and minimize the psychological,
social and vocational efforts of disability.

The services offered include cardiac rehabilitation program, orthotic

and prosthetic clinic, pediatric rehabilitation, musculoskeletal
rehabilitation, general orthopedic conditions, neuro-rehabilitation,
lumbar and cervical tractions, chest physiotherapy, hydrotherapy, gait
training, treatment of pain through Transcutaneous Electrical Nerve
Stimulator (TENS), laser and other electrotherapeutic modalities. The
section is planning to start geriatric and rheumatology rehabilitation
program.

Off-site Physiotherapy Clinics and Home

Physiotherapy Services

In response to the growing demand from patients and consultants from

within and outside AKUH, the Physiotherapy the Physiotherapy
Department has started home- physiotherapy services and off-site
physiotherapy clinics located at Clifton Medical Services and at Aga
Khan Diagnostic and Day Care Surgery Centre, Karimabad.
Highly qualified physiotherapists equipped with sophisticated
modalities treat neurological, neuromuscular, musculoskeletal and
cardiopulmonary disorders, and assure high-quality services.

AKUH Physiotherapy Department also provides feedback to referring

consultants, enabling them to assess the status of their patients and to
plan their future treatment accordingly. All these services are available
from Mondays to Saturdays from 8:30 AM to 6:00 PM.

Advanced Rehabilitation Services at Aga Khan University Sports and

Rehabilitation Centre provide quality multidisciplinary outpatient
rehabilitation by a skilled rehab team using the latest equipments, a
wide range of therapeutic exercises and a multitude of modalities to
help patients return to an active and healthy lifestyle.

Services offered are

• Fitness Screening through Microfit fitness evaluation system

• Fitness Weight reduction program
• Orthopedic rehabilitation program
• Neurological rehabilitation program
• Cardiac rehabilitation program
• Risk factor modification program
• Pulmonary rehabilitation program
• Sports Injury Clinic

Aga Khan University Hospital, Karachi provides a broad range of latest

and technically advanced diagnostics and therapeutic services. Over
the years, the hospital has developed a health care network, which
covers all areas of Karachi through Off-site Medical Centers, Home
Health Services and Clinical Laboratory Network.
Kindly visit above links for details regarding services offered by AKUH.
In case you are unable to find the service, you would like to avail,
please contact the Hospital Information Desk.

Special Services

Special services include various facilities that provide specialized

medical care for specific clinical problems. Special services use a
problem-oriented approach with inputs from various clinical experts
and specialized training of the persons providing the service.

The various special services available are:

• Angiography Suite/Cardiac Catheterization Laboratory

• Bone Marrow Transplant Clinic
• Breast Clinic
• Endoscopy Suite
• Family Planning Clinic
• Foeto-Maternal Clinic
• Gynae-Oncology Clinic
• Heart Clinics
• Infertility Clinic
• Intensive Care Services
• Lithotripsy Clinic
• Menopause Clinic
• Metabolic Bone Disease Clinic
• Nutrition Care Clinic
• Oncology Day Care
• Operating Room
• Pediatric Sub-Specialty Clinic
• Pain Clinic
• Parkinson's Disease and Movement Disorder Clinic
 • Pre-operative Anesthesia Assessment Clinic
• Psychiatric Day Care Service
• Sleep Well Clinic
• Speech Therapy Clinic
• Sports Injury Clinic
• Surgical Day Care Unit
• Uro-Gynaecology Clinic

Support Services

In addition to clinical and diagnostic services, the institution offers

various supportive and administrative services that help in providing
quality care to the patients. These services may benefit all the
referring physicians in getting access to information in areas of
relevant interest and addressing various non-clinical issues related to
the care of their patients at AKUH.

The following are included in Support Services:

1. AKUNET Services
2. Conference Secretariat
3. Department of Continuing Professional Education
4. Health Information Management Services (Medical Records)
5. Marketing Department
6. Patient Business Services Department
7. Patients Complaint Handling Services
8. Patients Welfare Services
9. Physician Referral System Coordinator

Consulting Clinics
Aga Khan University Hospital (AKUH) provides outpatient consultation
service to over 600,000 patients a year. Clinics are located at AKUH,
Stadium Road, at Clifton Medical Services (CMS) and Off-site Medical
Centers. The service comprises of:

• Consulting Clinics: Specialists' clinics from different sub-

specialties of Anesthesia, Family Medicine, Medicine, Obstetrics
and Gynecology, Pediatrics, Psychiatry, Radiation Oncology and
Surgery. Please visit Consulting Clinics Schedule link (top right).

• Executive Clinic: Annual health check-up programs, which help

in timely diagnosis of medical problems.

• Community Health Centre: Primarily offers low-cost Family

Medicine general walk-in clinics. A limited number of specialty
clinics are also available. The centre also offers
immunization/vaccination, minor surgical procedures such as
circumcision, pre-employment health check-ups and screening

Women's Services

Maternity
Aga Khan University Hospital, Nairobi (AKUH, N), Maternity Services is
accredited by the Royal College of Obstetrics and Gynecology, United
Kingdom. The service provides quality care at an affordable price,
offering would-be mothers a comfortable environment through each
stage of their pregnancy

Qualified nurses and midwives, a team of resident doctors under the

stewardship of senior obstetrics and gynecology consultants cater to
both the mother and child’s needs.
LDR

LDR consolidates the process of Labor, Delivery and Recovery process

in one room saving mothers the inconvenience of being moved from
room to room at various stages of labor. The unit offers an opportunity
for mothers to deliver in an environment in which they feel nurtured,
comfortable and their privacy and preferences respected. The first of
its kind in East Africa, and located at the prestigious Princess Zahra
Pavilion, the unit is the answer to many expressed needs of women in
maternity care; privacy, comfort, and choice. This addresses the
psychosocial needs of the family.

The LDR concept encourages natural childbirth and allows the mother
the option of remaining with family members and friends. The concept
is enhanced by the use of a special bed, which allows the mother to
deliver in any position of her choice in a state-of-the-art room. There is
round the clock monitoring of the mother during the birthing process
by an Obstetrician and mid-wives.

Lamaze

Lamaze is a method of childbirth preparation based on proven

scientific methods to provide a positive experience for the expectant
mother. Recognized internationally, the program is a popular method
of childbirth education and preparation. Couples are encouraged to
attend the six-week program which includes exercises, relaxation and
breathing techniques, labor and delivery experience, nutrition,
sexuality and coping skills for the postpartum period.

Maternity-Ward
The ward has a bed capacity of 25. It has state-of-the-art delivery
rooms with piped oxygen, neo-natal resuscitation units, comfortable
delivery couches and electronic external foetal monitoring devices. The
ward has:

• 12 ward beds;
• 8 semi-private rooms;
• 3 private rooms with television and telephone facilities;
• 2 private rooms specifically for monitoring high risk expectant
mothers.

UPCOMING SERVICES
‘HOSPITAL FITNESS’

Regular activity has a number of proven, positive health effects,

especially on heart health. Vigorous exercise strengthens the heart as
a pump, making it a larger, more efficient muscle. Even moderate
activity can boost HDL ('good') cholesterol, aid the circulatory system,
and lower blood pressure and blood fats. All these effects translate into
reduced risk for heart disease, heart attack, and stroke.
Exercise can also offer other benefits, including strengthened muscles,
increased flexibility, and stronger bones, which can help ward off the
bone-thinning condition called osteoporosis.

Regular activity also promises mental-health benefits, like relieving

stress and anxiety. It can help you sleep better and renew your energy.
If exercise could be bottled, it would be a best-selling potion at the
local pharmacy.

The reasons for inactivity are not hard to figure out. Most of us have
jobs where we sit most of the time, so chances are limited to be
physically active at work. We also rely heavily on modern, laborsaving
devices - cars, appliances, and power tools - to spare us manual effort.

But there's another reason why many people, especially the

overweight, avoid activity. Check out the firm, supple bodies shown
exercising on television or on magazine covers. They give the
impression that exercise is sweaty, strenuous work best reserved for
the young, super-fit, and athletic. However, the latest research is
proving that picture false: Benefits can be gained even from low-
intensity activity, like gardening.

Situation Analysis

The business model has been well received and marketing is especially
important to maintain growth and market penetration. In addition to
offering fitness facilities for hospital patients, its main activity is the
creation and implementation of wellness programs. The basic market
need is the permanent fitness of the patients that can be achieved
through long-term wellness programs.
Market Summary

Hospital Fitness possesses good information about the market and

knows a great deal about the common attributes of the prized and
loyal customers. This information will be leveraged to better
understand who is served, their specific needs, and how Hospital
Fitness can better communicate with them.

Market Analysis
2003 2004 2005 2006 2007
Potential Growt
CAGR
Customers h
13,33 18,00 24,30 32,80 35.00
Hospital Employees 35% 9,876
3 0 0 5 %
10,36 15.00
Patients 15% 5,924 6,813 7,835 9,010
2 %
0.00
Other 0% 0 0 0 0 0
%
28.57 15,80 20,14 25,83 33,31 43,16 28.57
Total
% 0 6 5 0 7 %

Market Demographics

The profile for Hospital Fitness' customer consists of the following

geographic, demographic, and behavior factors:
Geographies

• The immediate geographic target is the city of Karachi.

• A 35-mile radius is in need of the services. .

Demographic

• 71%:29% male: female.

• The individual income range is 38,000-75,000.
• 67% of the customers are single, 33% are married.

Behavior Factors

• Recognize the need to have physical activity in their lives.

• Have in Hospital some sort of exercise program in their daily/
weekly routine for the last several years.
Market Needs

Hospital Fitness is providing their customers with a health care cost

management program for hospital employees that will increase
employee productivity and decrease overall business costs. Hospital
Fitness seeks to fulfill the following benefits that are important to their
customers:

• Customization- HF will offer a totally customized solution for each

department as well as each employee within the company.
• Convenience- Customers will not use the service if it is not
convenient. HF recognizes this and strives to make their services
as convenient as possible for the targeted customer groups.
• Results-orientated strategy- HF will need to improve hospitals’
bottom line in order to attract and maintain customers. While HF
will strive to address all of the customer's needs.

Market Trends

There have been two significant market trends in the last five years.

• Increased usage of fitness facilities on behalf of individuals.

Exercising and "working out" has become a more mainstream
activity in lives over the last decade. Five to ten years ago, there
were widespread reports about an impeding health crisis,
obesity. The poor diet is not the only factor however more and
more people are going to the gym after work or are incorporating
some sort of outdoor activity into their daily routine.
• The incorporation of fitness memberships within the "basket of
benefits," a part of the total compensation package.
SWOT Analysis

The following SWOT analysis captures the key strengths and

weaknesses within the company, and describes the opportunities and
threats facing HF.

Strengths

• Results-orientated approach to attracting and maintaining

customers.
• A well-researched, detailed health wellness program that is long-
term in focus.
• Intensively trained staff.

Weaknesses

• High costs associated with customized, personal service.

• The inability to work on a high volume business model.
• The costs of attracting a large Hospital client.

Opportunities

• Participation within a growing market.

 • The large increase in clients that follows with the acceptance of
HF's program by hospital employees.
• The ability to leverage future quantitative analysis that supports
the contention that long-term wellness programs have a
significant, positive impact on a hospital’s bottom line.

Threats

• Lack of immunity to an economic downturn.

• A change in society where the individual begins to take far more
responsibility for his/her health maintenance.

Competition

The three main competitors for Hospital Fitness are:

• YMCA-market is lower-income families and/or students who want

accessibility and affordability of fitness facilities.
• General Gyms-services are targeted toward those motivated and
dedicated individuals who workout five to seven times per week.
• Better Bodies-aimed at casual fitness-seekers who do not
workout with a high intensity but still desire the status and
recognition.

Service Offering

Hospital Fitness provides wellness strategies/programs to businesses in

Karachi. A wellness strategy is a long-term effort, combining both
health-promotion and exercise-related activities designed to facilitate
positive lifestyle changes in members of a hospital’s work force.
Hospital Fitness will work with a hospital's senior management to help
it develop a mission statement for its wellness program.

Finally, Hospital Fitness will furnish employee progress reports to

senior management with which to carry out the incentive program and
generally monitor changes in the behavior of its work force.

Keys to Success

Hospital Fitness' keys to success are:

• Marketing services to patients and other individuals.

• Recruitment of experienced managerial talent.
• Dedication and hard work of the founders.
• Raising productivity.
• Lowering overall costs.

Mission

Hospital Fitness is a health service that helps hospital employees and

patients attain one of the greatest gifts of all--that of good health.
Personal gains, such as improved self-esteem and self-motivation,
combined with measurable benefits will create tremendous advantages
for both the employer and the employee.

Marketing Objectives

1. Generate a 10% yearly increase in sales.

2. Increase market penetration every quarter.
3. Continue to cultivate HF's image as the premier long-term
wellness program provider.
Financial Objectives

1. Decrease customer acquisition costs by 4% every two quarters.

2. Lower the cost of service delivery by 1% a quarter.
3. Holding spending, as a percentage of sales, at a steady rate.

Target Markets

The market for Hospital fitness is not particularly segmented, as

potential customers include all hospital employees

Hospital Fitness, however, segments its services for individual patients.

Hospital Fitness works with senior management to develop mission
statements and provide incentive plans, and with employees to design
personalized health and fitness programs.

The targeted customers are Hospital employees and patients.

Positioning

Hospital Fitness will position them selves as the most effective

wellness strategy and program developer. This positioning will be
supported by statistics indicating an increase in worker productivity
and a decrease in business operation expenses from the
implementation of Hospital wellness programs.

Strategy Pyramids
The single objective is to position HF as the most proficient wellness
program provider in the Seattle area. The marketing strategy will seek
to develop customer awareness regarding the services offered,
develop the customer base, and work toward building customer
loyalty.

The message that HF seeks to announce is that they can have a

dramatic effect on the bottom line. This message will be
communicated through various methods. The first method will be the
production and disbursement of printed materials. The printed
materials will describe all of the services offered and will give
prospective customers some insight into HF's past successes.

HF will also rely on presentations to hospital's HR departments. These

presentations will allow HF to personally address any concerns or
"pains" that hospitals have and indicate how a wellness program/
strategy can help service their needs.

HF will also rely on advertisements in the hospital Journal of Karachi for

increasing visibility and interest in HF's services among Seattle-based
companies. Lastly, Hospital Fitness will use a website as a source for
disseminating information.
Marketing Mix

Hospital Fitness' marketing mix is comprised of the following

approaches to pricing, distribution, advertising and promotion, and
customer service.

• Pricing- Prices for using Hospital Fitness' services are comparable

to those of higher-end fitness centers. An employee choosing to
utilize a Hospital Fitness center will pay a 400 monthly fee. For
each employee enrolled in the general wellness program,
regardless of whether or not they use the fitness facility, the
hospital will pay 150 annually. The prices reflect the quality of
the equipment and service.
• Distribution- This will occur both at the company's worksite as
well as at HF's facilities.
• Advertising and Promotion- Printed material, presentations,
advertising in industry specific journals and a comprehensive
website will be used.
• Customer Service- Hospital Fitness will operate on the principle
that it is imperative to achieve total customer satisfaction if the
business is going to succeed.

Marketing Research

Two types of market research were used when HF was collecting

market research. The first type of research was focus groups. The
focus groups were collections of seven to nine people who were asked
a series of predetermined questions with the responses recorded and
discussed among the group members. In addition to the pre-
established questions, there was a free-flow discussion format toward
the end of the focus group that provided flexibility in allowing the
participants to share information and insight with HF.

Additionally, questionnaires were used to collect market information

from perspective customers. The questionnaires were submitted to a
total of 10 HR professionals. The response rate was 100%, higher than
expected. The validity and usefulness of the questionnaire was
ensured by utilizing a graduate statistics student to develop the
questionnaire. Overall, both forms of primary market research were
insightful for providing this research confirmed many already held
assumptions as well as introduced several valuable perspectives that
HF was not yet privy to.

Financials

This section will offer a financial overview of Hospital Fitness as it

relates to the marketing activities. HF will address Break-even Analysis,
sales forecasts, expense forecasts, and how they link to the marketing
strategy.

Break-even Analysis
The break-even analysis indicates that $16,667 will be needed to reach
the break-even point.

Monthly Revenue Break-

$10,101
even

Assumptions:
Average Percent Variable Cost 10%

Estimated Monthly Fixed Cost $10,000

Sales Forecast
Please refer to the following chart and graph to illustrate the sales
forecasts.

Sales Monthly

Sales 2003 2004 2005

Hospital Employees $298,783 $389,776 $455,678
Patients $242,077 $288,739 $333,890
Total Sales $540,860 $678,515 $789,568

Direct Cost of Sales 2003 2004 2005

Hospital Employees $29,878 $38,978 $45,568
Manufacturing $24,208 $28,874 $33,389
Employees
Subtotal Direct Cost
$54,086 $67,852 $78,957
of Sales

Expense Forecast

The expenses forecast will be used as a tool to keep the department

on target and provide indicators when modification or corrections are
needed for the implementation and maintenance of the market plan.

The marketing expenses will be high during the first quarter of

operation, a quarter when there is increased usage of fitness facilities.
The expenses will settle a bit during the second and third quarter. The
expenses will rise during the fourth quarter, the quarter when HR
budgets are typically submitted/reviewed.
Marketing Expense Budget
2003 2004 2005
Pamphlet Production $1,000 $1,200 $1,400
Website
Production/Maintenan $9,200 $8,000 $8,000
ce
Other $9,250 $12,000 $14,000
------------ ------------ ------------
Total Sales and
$19,450 $21,200 $23,400
Marketing Expenses
Percent of Sales 3.60% 3.12% 2.96%
Monthly Expense Budget
Controls

The purpose of Hospital Fitness' marketing plan is to serve as a guide

for the organization. The following areas will be monitored to gauge
fitness:

• Revenue- monthly and annual.

• Expenses- monthly and annual.
• Customer satisfaction.
• Wellness program effectiveness within each company.

Implementation

The following milestones identify the key marketing plan programs. It

is important to accomplish each one on time an on budget.

Start Manage Depart

Advertising End Date Budget
Date r ment
Advertising 1/1/200 6/30/200 Marketin
$3,750 WIT
Campaign #1 3 3 g
Advertising 7/1/200 12/30/20 Marketin
$5,500 WIT
Campaign #2 3 03 g
Total Advertising
$9,250
Budget
 Start Manage Depart
PR End Date Budget
Date r ment
Pamphlet 1/1/200 Marketin
3/1/2003 $1,000 JWT
Completion 3 g
Total PR Budget $1,000
Start Manage Depart
Direct Marketing End Date Budget
Date r ment
Marketing Plan 1/1/200 Marketin
2/1/2003 $0 JWT
Completion 3 g
Total Direct
$0
Marketing Budget
Start Manage Depart
Web Development End Date Budget
Date r ment
1/1/200 3/15/200 Marketin
Website Completion $9,200 JWT
3 3 g
Total Web
Development $9,200
Budget
Totals $19,450

Contingency Planning

Difficulties and Risks

• Problems developing a sufficiently large client base.

• Significant economic downturns.

Worst Case Risks Include

• Determining that the business can no longer support itself.

• Having to liquidate equipment to cover liabilities.

Conclusion
Organizations should take a comprehensive look at their fitness
management system and have very objective goals that are tied to
strategic initiatives and the fitness management process. Successful
organizations have learned the secret to this and while not always
perfect, a constant striving to improve the process can help
organizations reach their Vision. An effective fitness management
process sets the foundation for rewarding excellence.