The new normal for private healthcare sector post COVID-19

Gautam Khanna, Co-Chair, FICCI Health Services Committee and CEO, P D Hinduja Hospital & Medical Research Centre (MRC) and Sonali Ila Ekka, Strategy and Healthcare Analyst, P D Hinduja Hospital & MRC  emphasise on the need for private hospitals to reassess their internal capabilities, the effect and limitations of the crisis, and develop a sound strategy to get operational

The COVID-19 pandemic has wreaked havoc across the globe. Till date, there have been over 57 lakh confirmed cases, more than 3.5 lakh deaths and above 23 lakh recoveries, globally. In India, there have been over 1.5 lakh confirmed cases, more than 4.5 thousand deaths and above 67 thousand recoveries.

Healthcare sector has been especially hit by the pandemic. Its plight is distinct from other sectors. The very people required to treat patients are at high risk of infection themselves and are irreplaceable because of their unique skills. Another distinct aspect which sets healthcare apart from others is that any delay or failure in delivery of healthcare services will result in worsening of health conditions.

Impact of COVID-19 on healthcare sector

India got its first reported case of COVID-19 in March’20. Indian hospitals are facing the challenge of demand exceeding supply, coupled with staff infection.

Hospitals took several immediate steps to tackle the threat of infection. They promptly implemented safety and precautionary measures for screening all patients, visitors and staff; use of masks and PPE; ample supply of hand sanitisers at all points and social distancing inside the premises; thorough and frequent cleaning of all exposed surfaces and equipment; special processes in housekeeping, laundry, food services, CSSD, biomedical waste management, etc.

Existing infrastructure was modified to create isolation facilities. Separate areas had to be created for triage and swab collection; and for clinical staff directly involved. Technological solutions were implemented e.g. teleconsultation, tele – triaging, UV sanitization, robots for transportation, digital communication with patients, data analytics for decision making etc.

Purchase costs increased due to additional consumables and equipment required, need to stock-up supplies and supply shortages.

Additional costs were also incurred to provide medical, transport and accommodation facilities for staff, including those who were infected. To add to this, manpower strength was reduced either due to lockdown or staff getting infected.

The risk of infection and lockdown forced hospitals to shut down non-emergency and elective OPD and IPD services. Patients also avoided hospital visits. Non-emergency surgeries remain suspended.

The dual effect of rising costs and falling revenues has added a huge burden on private hospitals, threatening their financial sustainability.

Hospitals have already adopted new working styles because of COVID-19. All staff practice social distancing at work, communicating through phone calls, instant messaging, call conferencing and emails.

Cross-functional task forces have been created. Reduced manpower has forced hospitals to focus on multitasking as well as to explore technology solutions to improve efficiency and enable staff to operate safely. Earlier, only specific clinical teams would use masks, PPE and hand sanitisers for specific situations, like surgical teams before a surgery. Today, every hospital staff has to wear masks and follow infection and safety protocols while working, and even when traveling home.

The new normal

COVID-19 is here to stay for some time. The Indian private healthcare, which constitutes >60 per cent of total beds, >60 per cent of total inpatients, >80 per cent of total doctors and provides most of the secondary and tertiary medical care, needs to resume operations immediately. Challenges like limited manpower and resources, high operational costs and risk of infection continue, but there will be the challenge of handling the pent up demand for medical treatment which had been delayed during the lockdown, while treating new patients, as well as the threat of monsoon-related diseases like dengue.

Protocols and facilities which had been set up for the pandemic will have to be followed in the long run. This will involve a complete change in the working culture within a private hospital. The continuous use of masks and PPE and protocols may seem tedious in performing daily activities, but staff will have to adhere to them. Continuous monitoring and tracking may be required, without being overtly intrusive.

The way medical care itself is sought and delivered may change. Before the pandemic, patients would either visit doctors often, or postpone their visits until absolutely necessary. Now, patients will prefer to substitute physical visits as much as possible with teleconsultations coupled with homecare services, and remote monitoring will be widely adopted. Eventually, these services will become integrated into comprehensive packages and included in insurance plans. Moreover, patients will more actively manage their own health conditions, adopt healthier lifestyle to avoid getting ill, or worsening of existing conditions to avoid hospitalisations. This will increase the demand for health awareness, digital patient-doctor communication, health tracking gadgets, remote diagnostic devices, etc.

The perceived safety of a hospital will also become important. Patients will avoid visiting hospitals which they fear is safe from infections. Hence, not only will hospitals have to improve their quality, they may also have to ramp up their patient communication to gain their trust. Minimum standards of care delivery will be raised and hospital accreditations will become an important criterion, besides price and doctors.

There will also be a significant shift from curative to preventive medicine, to reduce hospitalisation and hospital visits. Hospitals will begin to consider a holistic healthcare services including screening, testing and follow-up, ensure high patient compliance and patient education.

Big data analytics can help clinicians and hospitals alike, to gather valuable insights about the pandemic and develop more effective treatment methods. Technology can help in that, but this would require changing the way hospitals operate, so as to enable data collection.

The pandemic will change the way doctors operate. Many have already started teleconsultation during the lockdown and will continue to do so. e – Learning modules have also been adopted for continuous medical and nursing education. Globally, several libraries and repositories have made their clinical journals and resources available online for doctors. Clinical teams across the world are collaborating to share insights and guide each other for COVID-19 treatment and protocols. Even within hospitals and countries, more cross-specialisation collaborations have come up for treatment and patient care.

The pandemic has helped break down the silos which traditionally dominated hospitals. The risk of infection has driven teams to collaborate, cooperate and communicate clearly and effectively. The organisational structures have become flatter with front-line staff given more empowerment to take decisions and actions, while keeping all stakeholders informed. Technology has again played a crucial role for effective communication, surveillance and monitoring, and efficiency. With rapidly changing regulations, protocols and new challenges posed in patient care, tasks have become less bureaucratic. This new style of working gives each staff a sense of ownership which increases motivation and could lead to more innovations.

In terms of healthcare infrastructure, due consideration will be given to reinforcing and expanding isolation facilities and ICUs. The pandemic showed how the world initially grappled for more ventilators and even Ford Motors in the United States of America (USA) started manufacturing them in their car facilities. Medical device companies will also ramp up their capacity to make more PPE, ventilators, etc.

The pandemic also emphasised the importance of primary healthcare along with affordable secondary and tertiary care. Public spending on healthcare has to be increased to add more infrastructure, as well as to provide innovative financing solutions to make secondary and tertiary care more affordable for citizens while ensuring sustainability for private hospitals. PPPs among all stakeholders, including insurers, will play a crucial role in achieving this.

Conclusion

Every crisis poses an opportunity to learn, improve and innovate. However, speed and deliberation are of the utmost importance. Private hospitals need to reassess their internal capabilities, the effect and limitations of the crisis, and develop a sound strategy to get operational. Although, this requires support from all stakeholders, including the public, the government, payers, entrepreneurs and other healthcare players.