1.1.

HEALTH CARE INDUSTRY

India is perched to witness additional growth in its economy as a result of positive trends within the healthcare sector. Reports clearly suggest that healthcare sector is going to be one of the major sectors that would fuel the economic growth and will contribute to the increased revenues, along with IT Services and Education sectors in the country. Over 40 million new jobs and 200 billion increased revenues are expected to be generated by the Indian healthcare sector till 2020, as per a report titled, Indias New Opportunities- 2020, prepared by the All India Management Association, Boston Consulting Group and the Confederation of Indian Industries (CII).

1.1.1 Healthcare Market Size The Indian healthcare sector is poised to reach US$ 280 billion by the year 2020, thereby contributing an expected Gross Domestic Product (GDP) spend of 8 per cent by 2012 from 5.5 per cent in 2009, according to a report by an industry body. A US$ 36 billion industry today and growing at 15 per cent compound annual growth rate (CAGR), the Indian healthcare industry will reach the market value of US$ 280 billion by 2022. Increasing population, higher expenditure on lifestyles, rising market of health insurance, government initiatives for better medical infrastructure, and focus on Public Private Partnership (PPP) models are some of the driving factors for the growth of healthcare sector in India. Major players in the Indian healthcare sector include Apollo Hospitals Enterprise Ltd, Fortis Healthcare Ltd, Max Hospitals and Aravind Eye Hospitals.

1.1.2 A GROWING HEALTHCARE SECTOR

Healthcare is one of Indias largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. During the 1990s, Indian healthcare grew at a compound annual rate of 16%. Today the total value of the sector is more than $34 billion. This translates to $34 per capita, or roughly 6% of GDP. By 2012, Indias healthcare sector is projected to grow to nearly $40 billion. The private sector accounts for more than 80% of total healthcare spending in India. Unless there is a decline in the combined federal and state government deficit, which currently stands at roughly 9%, the opportunity for significantly higher public health spending will be limited. 1.1.3 GROWING POPULATION AND ECONOMY One driver of growth in the healthcare sector is Indias booming population, currently 1.1 billion and increasing at a 2% annual rate. By 2030, India is expected to surpass China as the worlds most populous nation. By 2050, the population is projected to reach 1.6 billion.

INTRODUCTION TO HOSPITAL
Dr. Nalla G. Palaniswami Chairman KMCH

Kovai Medical Center and Hospital is 800-bed multi-disciplinary super-specialty hospital located in the NH 47, opposite to Airport, Coimbatore. The hospital has more than 50 medical disciplines managed by highly qualified and trained full time medical specialists providing round the clock service. Over 1000 in patients and out patients are treated every day at the hospital. KMCH is equipped with state-of-the art medical equipments such as MRI, 64 slice Volume CT Scanner, 4D Ultra Sound Scanner, Flat panel Cath Lab, Cardiac Electro-physiology Lab, Bone mineral Densitometer, Mammography, Laser equipments, Video endoscope, Operating Microscope, Auto analyzer, Computer Assisted Navigation for hip and knee replacements, ESWL for the removal of urinary stones.

1.2.1 VISION
KMCH will be a health care leader in India by providing excellent quality medical care and services to patients in a family focused environment.

1.2.2 MISSION
KMCH will improve the health and well being of the community by providing world class patient care, education and training. KMCH is the only center in south India which has introduced a new technique known as GDC coils and clipping of Brain Aneurysms. KMCH has made a breakthrough in the treatment of Stroke Management and Uterine Fibroids with the latest technique in Interventional procedures. The state-of-the-art Fertility Center at KMCH is well equipped to do the Assisted Conception program like IVF, ICSI to the International standards. Most advanced treatment techniques are adopted here. KMCH is recognized for organ transplant programmes by the Government of Tamil Nadu. Several Kidney transplants and corneal transplants from live donors and cadavers have been done. KMCH is also recognized by the Tamil Nadu Government to do Heart and Lung transplants. KMCH has specialized clinics like Asthma clinic, Diabetic clinic, Slim clinic, Pain clinic, Deaddiction clinic, Painless labour clinic, Andrology clinic, Diet clinic etc., Various specialized procedures like Chemoembolisation, stenting, fallopian tube recanalisation, Chemotherapy,Blood component therapy, Arthroscopic surgeries, Laparoscopic and Thorocoscopic surgeries are

regularly done at the hospital. The hospital has a separate department for artificial limb manufacture.

KMCH IS RECOGNIZED FOR THE FOLLOWING SCHEMES

Income tax under section 17(2) B for KMCH main center, Coimbatore. Tamilnadu Government Employees Health Fund Scheme administered by Star Health and Allied Insurance Company Limited. Tamil Nadu Government Pensioners Health Fund Scheme. Unit Trust of India Senior Citizen Plan. Prime Ministers National Relief Fund. Chief Minister Relief Fund. Ministry of Health & Family Welfare Discretionary Grant. Kerala Government Servants Medical Attendance Rules-1960.Employees State Insurance [ESI] for super specialty procedures and surgeries.

1.2.4 APPROVED TPAS/INSURANCE COMPANIES FOR CASHLESS TREATMENT:

Bajaj Alliance General Insurance. Cholamandalam General Insurance. Star Health and Allied Insurance company Ltd. Medi Assist. Good Health plan Ltd. Genins India. Medicare. MD India Health care. Parmount Health care services. United Health care.

ICICI Lombard.

DEPARTMENTS

Emergency Department
An emergency department (ED), also known as accident & emergency (A&E), emergency room (ER), emergency ward (EW), or casualty department is a medical treatment facility, specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance. The emergency department is usually found in a hospital or other primary care center. Due to the unplanned nature of patient attendance, the department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. In some countries, emergency departments have become important entry points for those without other means of access to medical care. The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be varied in an attempt to mirror patient volume.

Dietary
Qualified dieticians will visit the patients every day and explain about their restrictions and prescribed diet. There is also a diet clinic in the ground floor (Level-0) for outpatients where patients referred by doctors, are counseled regarding their diet requirement. As a hospital policy patient / patient relatives and visitors are not permitted to bring outside food into the hospital. Patients and patient attenders are advised not to bring food and eatables from outside to the hospital.

Cafeteria
Food will be served at the room for the patients only. Patient attenders, relatives and guests are advised to go down to the canteen located on the backside of the main hospital building for food. Diet will be provided to the patient free of charge as per the fixed menu chart.

Pediatric
A pediatric intensive care unit (also paediatric), usually abbreviated to PICU area within a hospital specializing in the care of critically ill infants, children, and teenagers. A PICU is typically directed by one or more pediatric intensivists or PICU consultants[1] and staffed by doctors and nurses who are specially trained and experienced in pediatric intensive care. The unit may also have nurse practitioners, respiratory therapists, physician assistants, physiotherapists, social workers, child life specialists, and clerks on staff although this varies widely depending on geographic location.

Pharmacy
The hospital pharmacy is run by pharmacists, pharmacy technicians and attached staff. It's responsible for drug-based services in the hospital, including: the purchasing, supply and distribution of medication and pharmaceuticals inpatient and outpatient dispensing clinical and ward pharmacy the use of drugs.

A pharmacy will provide a drug formulary for hospital doctors to use as a guide. It will also help supervise any clinical trial management and ward drug-use review.

Housekeeping
Housekeeping is a very critical function in hospitals. This issue we bring you a variety of articles which can add values to managing this important aspect within your hospital. The main functions of housekeeping is overall cleanliness, ensuring maintenance of the building and its infrastructure, linen management, waste management, pest control, infection control, safety and security of the patients as well as the infrastructure and interior decoration. All this ensures the ambience promotes a healing environment. Even though outsourcing is an option available for housekeeping if one decided to have housekeeping as a department within the hospital it needs to be managed well. For this articles are provided from recruitment, to maintaining records, job descriptions, to training available for housekeepers.

Maintenance
Maintenance means preserving and keeping things in good working condition, through prevention, detection and correction of faults, damage and wear. The best way to preserve infrastructure and equipment and keep everything running efficiently is to do maintenance checks at regular intervals and repair any parts that are likely to wear out or have worn out. These inspections must be done by competent and properly trained people.

Linen
This involves all functions from purchase of linen to laundering to condemnation. In a hospital different types of clothes and linen are used. The theatre gowns worn by doctors and patients, the doctors coats, bed sheets, additional sheets and pillow covers. In addition to these, we also have napkins, towels, hand towels, table covers, curtains, and cushion covers. It is the job of the Housekeeping Department to ensure clean and hygienic washing of all these items, and then distributing them to different areas of the hospital.

Waste
Waste constitutes a problem, the size of the problem varying with the size of the institution, because waste must be disposed of economically and efficiently, and in a sanitary way. Safety against fire, prevention of cross-contamination by infectious materials, odor control, and pest control are all included in waste disposal procedures. A carefully planned program of waste disposal will safeguard not only personnel and patient but also the community.

Following disciplines / facilities should be accommodated in the OPD 1. Medicine: General Medicine Chest & TB Endocrinology

2. Surgery: General Surgery Laparoscopic Surgery

3. Obstetric & Gynecology 4. Orthopaedics 5. Paediatrics 6. ENT 7. Dermatology 8. Urology 9. Dental 10. Gastroenterology 11. Homeopathy 12. Ayurvedic 13. Blood Collection Room

Support Services: Following Support Services shall be provided: o Operation Theatre Block with 2 ORs o Emergency Block with 5 beds and one Minor OT o Blood Bank o Radiology (Conventional X-Ray & Mobile X-ray, CT will be planned later on)

o Ultrasound o Pathology Lab o Physiotherapy (Both OT & PT). It should be a well equipped area as the VSS will also run two courses for students. One is in Physiotherapy and the other is in Nursing. o CSSD (Central Sterile & Supply Department) o Central Medical Gases o Pharmacy o a. Shop

b. Bulk Store o General Stores o Kitchen / Canteen o Mortuary o Biomedical Waste Management o Generators This will comprise of hospital kitchen for preparation and distribution of general, special

and therapeutic diets to the patients and commercial catering for ambulatory patients, their relatives and staff, sterile supply services (C.S.S.D.) for recycling and replenishment of reusable sterile supplies to various areas of patient care; medical records services for management of hospital informatics including filing and retrieval of outpatient records and statistical evaluation of hospital performance; medical and general store for inventory management of hospital supplies and their distribution to the areas of patient care.

Hospital Services: The hospital will have the following three major services: a. EMERGENCY SERVICES b. OUTPATIENT SERVICES c. INPATIENT SERVICES

a .In the EMERGENCY SERVICES (EMR), which will be operating round the clock,
there will be qualified medical and paramedical staff to attend to any emergency, including

trauma cases, which is increasing in the region everyday. There will be well equipped emergency operation theatre, with the facilities for general / special surgical procedures. Round the clock X-ray and Laboratory services are attached to the emergency services.

b. In the OUTPATIENT SERVICES (OPD), specialist consultation facility will be available

through out the week or on specified days both in the morning and evening. The patient services will be ably supported by diagnostic services and laboratory services.

c. In the INPATIENT SERVICES (IPD), facilities will be made available for all Surgical
and Medical cases, except in the case of infectious / communicable diseases. The super speciality cases like Cardio-Thoracic Surgery, Micro Neuro-Surgery, Renal Transplant Surgery, etc. will be referred to big hospitals in the city / region. Special equipment will be made available for Paediatric and Neonatology inpatients and also for ICU/CCU. Diagnostic Facilities: -

a. RADIOLOGY DEPARTMENT:
X-Ray imaging plays an important role among various imaging modalities. We propose to have a well equipped X-ray Department to cater to the needs of Traumatology and other hospital departments. There will be a high powered X-ray system with an image intensifier TV facility to do all the special investigations. This will help to reduce the patient radiation dosage while screening and also carryout various procedures.There will be another Portable X-ray Machine to take care of needs of the critically ill patients in ICU/ICU/OT etc. A mobile C-arm image intensifier is also planned for this department.

b .SONOGRAPHY:
Ultrasound has become a powerful non-invasive diagnostic modality today. We propose to use a multipurpose ultrasound machine for all medical / surgical and Obs./Gynae work of the hospital.

c. LABORATORY SERVICES:
Clinical laboratory plays an important role in the diagnosis, prognosis and treatment of

diseases. At our hospital, laboratory services will function under the head a Pathologist. Biochemistry department will have the latest multichannel auto-analyser and electrolyte analyser. In the haematology department there will be electronic cell counters, blood coagulometers etc. Pathology and Microbiology will be equipped as per the modern needs of hospitals.

d. Video Endoscopy will be provided as an outpatient procedure in the field of

Gastroenterology.

The Engineering Services: Engineering services of the hospital will comprise of a sub-station for maintenance of electric supply to the hospital; public health services for water supply, sanitation and fire protection and fire fighting systems, space heating, ventilation and air-conditioning for environmental management of essential areas in the hospital including intensive care, critical and operative care areas, selected intermediate care areas and laboratories. Solar heater with water boiler for hot water supply during winters along with Rain Water harvesting system will be part of the project. Sewage Treatment is to be done before flushing it to municipal system. Communication services comprising of integrated network of EPABX, public address and nurse call system; medical gases and vacuum services to provide un-interrupted supply of Oxygen & Nitrous oxide, and central vacuum to intensive, critical and operative area Diesel Generators and Invertors / UPS will be provided to supply uninterrupted power to all areas especially to critical floor.

Administrative Services: This will consist of accommodation for the Chief Executive, Medical & Nursing administrators; Personnel, financial & materials management, computerised hospital information and ancillary accommodation for transport, security, fire, housekeeping and building maintenance staff.

LIST OF MAJOR EQUIPMENT

Service Equipment: Ambulance Central Air-conditioning PlantCentral Oxygen / Vacuum, N2O Piping Sterilizers / Autoclaves Electrical Transformer, Generator & Electrical Fittings Electronic Telephone Exchange Fire fighting Equipment Lifts Kitchen, Mortuary equipment

Medical Equipment: X-ray Machines (Conventional & Mobile) & Dark Room Accessories Mobile Image Intensifier (C-Arm Machine) ECG Machines, Defibrillators, Nebulisers etc. Ultrasound Machine Patient Monitoring Equipment Ventilators Infusion Pumps/Syringe Pumps Blood Chemistry Auto Analyser Electronic Cell Counter (Haematology Counters) Electrolyte Analyser

Miscellaneous Lab Equipment Theatre Equipment for 2 Theatres (OT Lights, Tables etc.) Anaesthesia Machines Operation Microscope Video Endoscopes Hospital Beds & Furniture Physiotherapy Equipment Nursery Equipments (Phototherapy, Radiant warmers etc) Dental Chair, Dental X-ray alongwith other accessories. ENT Work Station, and Audiometers Physiotherapy Equipments (Ultrasound Therapy, Short wave therapy, TENS, ICT, etc Surgical Instruments & Other Miscellaneous Items.