Healthcare ventures in the private sector in India have always been for-profit entities but some charitable hospitals in India have managed to focus on growth and impact society without altering their philanthropic DNA. Sir Ganga Ram Hospital (SGRH) is leading the pack, practicing charity as a belief and not as a statutory compliance By M Neelam Kachhap
A 675-bed multi-speciality, state-of-the-art hospital in the heart of Delhi, Sir Ganga Ram Hospital (SGRH) needs no introductions. The hospital is known for clinical excellence and its work has achieved national and international recognition. The hospital is also widely recognised for its postgraduate teaching and academic activities.
“Amongst the hospital’s regular clientele are many public figures like the Prime Minister, Chief Ministers, Governors and senior politicians, CEOs of multinational and public sector undertakings, sports and media personalities and from time to time, even the first citizen of the country,” says Dr Dr DS Rana, Chairman, Board of Management and Emeritus Consultant-Nephrology. “The hospital has been decorated with many awards like International Outstanding Hospital Award in Community Care and Infection Control Practices and Community Service; and its consultants have been awarded the highest national awards like Padmabhushan, Padmashree, BC Roy Awards, and other professional and industry awards,” Dr Rana adds.
SGRH’s vision is to be a leader in healthcare delivery, medical education, training and research and to meet the changing expectations of the community. Keeping this vision in mind, the hospital has managed to focus on a comprehensive long-term value proposition rather than short-term, financial-driven perspective. SGRH ensures cutting edge technology, community health programmes, and facility enhancements; all focused on the patient.
Deep rooted belief
What differentiates SGRH from other private hospitals is their belief in charity coupled with clinical excellence. This means that the 60 year-old-hospital invests in technology and talent at par with other private hospitals, at the same time catering to all strata of the society, irrespective of their paying capacity. Apart from
the 20 per cent beds that the hospital keeps aside for patients belonging to financially weaker sections of the society, it also provides 40 per cent of its beds at a subsidised rate.
The hospital is the legacy of renowned philanthropist Sir Ganga Ram who lived in Lahore during the pre-independent era and sought to use his wealth to make his hospital a vehicle for social change. Later, a trust was created in his memory which till today runs the hospital. A Board comprising staff doctors manages the day-to-day operations of the hospital under the aegis of the Trust.
Independent governance
SGRH rode to success largely on the strength of its clinical excellence and has gone on to make a lasting impact on Delhi’s healthcare landscape, the patients as well as the world at large. What’s particularly fascinating is how each machinery working at the hospital is in tandem to bring out the best in clinical practice, teaching and research.
“The hospital is governed by a Board of Management comprising medical consultants of eminence, some with international standing. The Board of Management operates under the overall guidance of the Sir Ganga Ram Trust Society,” says Dr Rana. SGRH is for-purpose rather than for-profit organisation, insists Dr Rana. “The Trust has no financial interest in the hospital. It functions as a watchdog or guardian and does not interfere with the working of the hospital,” he adds. “We (the Board Members) are managers for the people. We just manage the funds and see that the hospital runs smoothly. We don’t get remunerated for this. All Board positions are honorary positions,” explains Dr Rana.
Cornerstone of SGRH
The foundation of SGRH healthcare service lies in the belief that affordable access to healthcare can be provided by cross-subsidy where high-income individuals contribute to the financing of healthcare services needed by low-income individuals. “The upper class patients subsidise for the middle class, middle class subsidise for the lower class and the hospital compensates for the below-poverty-level (BPL) patients,” says Dr Ajay Swaroop, Honorary Joint Secretary-cum-Treasurer and Senior Consultant, ENT. “This allows even the poorest patient to avail of cutting edge technology and latest treatment options with dignity,” he adds.
Although in Delhi, hospitals are obligated to provide free treatment to economic weaker section (EWS) of the public not all hospitals follow through. Patients of EWS category are entitled to 10 per cent of total in patient beds and 25 per cent of out patient facility completely free of charge. SGRH has been profiding free facilities to 20 per cent of patients. SGRH also provides 40 per cent of its beds at a subsidised rate.
“At SGRH, 20 per cent of the beds are earmarked for EWS people,” says Dr SP Byotra, Honorary Secretary and Emeritus Consultant, Medicine. “On these beds, all facilities (boarding, lodging, investigations, medicine and operative procedures) are free. In addition to that the hospital has a specialised outpatient department for all disciplines in which patients are seen free of charge. These facilities are provided strictly on a first-come first serve basis,” he adds.
At any given time the hospital has over 95 per cent occupancy rate, one of the rare hospitals in the private sector to have this high occupancy rate. “When the hospital started, the forefounders were very clear that SGRH is a charitable hospital. Even with changing times we have been able to stick to that practice religiously,” adds Dr Swaroop.
Transparent pricing
Even before the world started debating on price transparency, SGRH has gone ahead and made it a regular feature at the centre of their practice. “Hospitals need to be increasingly transparent about costs. It’s becoming a trend that is already taking hold but hasn’t yet reached critical mass,” says Dr Swaroop. “We help patients understand our pricing and are available to answers their questions about healthcare prices. Patients should compare prices among providers, and manage their out-of-pocket costs,” he further adds.
Consultants’ contribution
A distinguishing feature of SGRH is their unique model of governance. The day-to-day hospital management is handled by the Board of Management, consisting of hospital clinicians. The consultants share the revenue earned by them to contribute towards the development and growth of the hospital. “At SGRH, the doctors contribute a percentage of their earnings to the growth of the hospital. This is a novel way to nurture the workplace and engage the employee at a higher level,” says Dr Rana. This gives a unique sense of belonging and pride amongst the doctors. “Staff contributes 12-15 per cent of their total earning to hospital development, they feel part of the hospital,” says Dr Swaroop.
Coordinated care
One of the reasons for SGRH’s success is the availability of coordinated care at the hospital. The hospital provides coordinated care throughout the entire continuum of care — from outpatient office visits to inpatient stays and post-acute rehabilitation. The hospital has also been developing a standardised care path for some of the most common conditions treated at SGRH. “An interdisciplinary team of doctors within each centre of excellence collaborates to develop a care pathway to reduce unnecessary variability,” said Dr Rana. This will ultimately reduce costs and help manage time more effectively both for patients and doctors,” says Dr Rana.
At par with changing times
Another important consideration at the hospital is to keep current. Whether its a state-of-the-art hospital management software or a latest radiology equipment or a robotic surgical enhancement, SGRH has always been engaging current technologies to stay relevant to its patients. There are several departments of the hospital that have been recognised as Institutes and Centres of Excellence. “This represents the collaborative effort between the hospital, industry, university and academic bodies and the government,” says Dr Byotra.
SGRH strives to keep current by frequent upgradation. “When you [upgrade], patient visits and volume increase. People like to go to a modern, more efficient facility. It makes a difference.” says Dr Rana. Regular upgradation of the facility results in better indoor environmental quality, improved patient safety, more efficient and flexible facilities, and higher patient and staff satisfaction. “Hospitals must renovate to achieve optimisation of existing infrastructure which results in achieving functional excellence required for the healthcare needs of public and service provider,” reiterates Dr Rana.
Community engagement
The hospital is committed to deliver long-term value to both their stakeholders and society. The hospital is adding to societal investment programmes to become more strategic and innovative, and infuse purpose throughout the entire organisation. SGRH engages with the community through its Ladies Welfare wing. Many activities like the TB eradication programme, mobile clinics and disaster management are the working of the Ladies Welfare wing.
Long-term value to employees
It is a known fact that HR costs are about 30 per cent of the total hospital cost and it is very tricky to retain good talent in India. Average attrition rate in hospitals is about 15 to 25 per cent, yet SGRH has managed to keep most of its talent intact. “Most of the doctors who joined us initially were looking for a good teaching environment with impetus for research along with competitive salaries. We were able to provide all three requirements,” says Dr Rana. Of course, the hospital also suffered some setback when their celebrated Minimal Access, Metabolic and Bariatric Surgeon decided to part ways and their busy liver transplant surgeon found a new job, however the hospital seems to have recovered from the setback, says Dr Rana. “When an employee leaves, the relationships that he/she built for the hospital are severed, which could lead to potential customer loss. Also, continuity of care is severed, which causes a lot of discomfort for the patient leading to dissatisfaction. However, we do not have problems like that at present,” informs Dr Rana. The hospital is creating fully integrated opportunities to engage a the employees, says Dr Byotra. “People who work here (SGRH) have the passion to teach, share knowledge and are content with their clinical work,” states Dr Byotra who has been with the organisation for more than 30 years. “Give the best to life and you will get the best,” he says philosophically. “I’ve been working here since 1984 and find working here very comfortable,” says Dr Swaroop. “There is a steady and gradual growth path for all employees and there is a hierarchy system. However, the management does not set any financial goals for its doctors. One gets to do absolute ethical work here,” explains Dr Swaroop.
Investing in future
Having a self-sustaining business model has its disadvantages. The pace of growth slows down as growth capital for expansion to other locations are limited. “Our unique model of tertiary healthcare delivery is good for self-sustenance, the hospital does not depend on any financial contributions of any external agency,” says Dr Rana.
“However, it limits us in a way that we cannot reach other locations,” Dr Rana adds. “Many hospitals have approached us in the past to lend our name to them. We could have had a chain of franchise based hospitals under our name, but we were sceptical of their intent and did not want to spoil the brand so we did not move forward,” shares Dr Rana. “However, we do feel that we need to have some critical mass in terms of number of beds or hospitals. We are mulling over expansion plans for other locations like Delhi-NCR, Noida, Gurgaon,” informs Dr Rana. These will be a mix of greenfield and brownfield projects, he says.
Expansion plans
The hospital has been facing space constrains as the number of patients visiting the hospital has been on the rise. “There is a shortage of space, and we want to extend our services. There are still patients whom we cannot accommodate. We want to expand our facilities and education. The present day facility doesn’t allow that,” says Dr Rana. In its endeavour to provide state-of-the-art facilities and to meet the increasing demand of patient beds, the hospital has undertaken phased renovation of old blocks and will soon start construction of four new blocks and an 11-storey car parking, around five lakh sq feet of additional area. “In the first phase of the master plan 2021, to be completed in the next three years, the hospital intends to add around 250 beds in addition to a multi-level car parking to accommodate 1100 cars,” says Dr Rana.
In times to come
Today, SGRH remains at the forefront of healthcare. It is the first hospital in the country to have a bone bank and the only hospital with a genetic diagnostic department performing genetic studies and providing counseling. It houses nationally recognised centres of excellence, including those in critical care and emergency medicine, child health and renal sciences and it provides groundbreaking programmes that improve access and quality of care to the most vulnerable populations. In partnership with Guru Gobind Singh Indraprastha University, SGRH provides valuable training for future leaders in health care. With the hospital block in the pipeline, SGRH capabilities will continue to grow, serving diverse patients with some of today’s most complex and chronic problems.