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Indian healthcare is in the process of offering a plethora of services to customers hailing largely from India and from neighboring countries. The Indian hospital sector consists of private “nursing homes” and government and charitable missionary hospitals. Government and missionary hospitals determine their charges according to patients' income levels and treat poor patients freely. Nursing homes charged higher, market‐determined rates. They offer services in just a few medical specialties, owned and operated by physicians who worked with them. Nursing homes cannot afford the latest medical technology, but they provide more intimate settings than government hospitals. This case study aims to demonstrate the various strategic options available to a for‐profit hospital, in an emerging economy with a burgeoning middle‐class population and how it can choose which services that it can best offer to its target population.

Diagnosing and treating complex ailments in nursing homes could be a time‐consuming and expensive proposition as visits to several nursing homes with different specialties may be necessary. This paper demonstrates how an hospital can develop new customer‐oriented services and eliminate the hassle for patients needing to run around different healthcare outlets even for minor ailments.

The paper finds that large government hospitals generally have better facilities than nursing homes, but they were widely believed to provide poor‐quality care. They failed to keep up with advanced equipment, train their technicians adequately and did not publicize their capabilities to doctors who might refer patients. Many missionary and charitable hospitals were undercapitalized and did not offer all services. These conditions left an unsatisfied demand for high‐quality medical care. In 1983, LIFENET opened in Madras, becoming the first comprehensive, for‐profit hospital in India. LIFENET, invested in a cardiology laboratory and clinics with capacity to diagnose heart and lung ailments, which grew through referrals it received from other doctors.

Out of promoters' shared vision and the persistence to overcome financial and regulatory hurdles, LIFENET turned into a super specialty hospital. In early 2004, LIFENET promoters considered several options for expansion. In addition to building more hospitals, they considered licensing the brand name and establishing India's first health maintenance organization.

Need for preventive health care: To comprehend the contribution of preventive health care in improving the health quotient. Sri Sathya Sai Sanjeevani Hospital (SSSSH) and its initiative is an apt example of the wonder which preventive care can bring in the context of rural health. Community participation: The case can be instrumental in showing the pathway to encourage community involvement in mainstream health by promoting the holistic model of SSSSH that understands mothers and children's health profile and needs, especially in the unreached rural segments of an emerging economy like India. Importance of healthy childhood: World Health Organization (WHO) promotes the school health programme to prevent health risks among children by inculcating healthy behaviours during childhood. The successful SSSSH model proves that it is implementable by integrating comprehensive health education modules in the existing institutions for medical care.

The challenge of a healthy childhood is inadequate availability and accessibility of quality care. Non-awareness of the parents is also a significant reason for the children who miss the benefit of a happy childhood. While much is planned by the Government and some part of it being executed, this case highlights the effectiveness of the maternal and child health programme executed by the Sri Sathya Sai Sanjeevani Hospital (SSSSH). This initiative fulfills the dire need of ensuring the preventive healthcare component leading to safe motherhood and safe birth of healthy children. Further, the case is also the culmination of pin-pointed innovative awareness activities such as school health screening and the Divine Mother and Child Health Program (DMCHP). It opens up the discussion on the current model of health care followed by SSSSH, Raipur, and its impact in the local areas to decide on its expansion across the country for nationwide implementation.

Bachelors in Business Administration, MBA, Executive MBA, Post Graduate Diploma in Healthcare Management

Teaching notes are available for educators only.

CSS 2: Built Environment.

Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

The purpose of this paper is to discuss the role of psychosocial treatments to support families living with cardiovascular disease (CVD) and depression. The paper highlights that depression in people with CVD is a predictor of non-adherence to both medicines and cardiovascular rehabilitation programmes. The authors believe there is a clinical need to develop a programme of care to support the whole family to adhere to cardiovascular rehabilitation programmes.

A team of expert cardiovascular nurses, mental health nurses (MHN) and cardiologist clinical opinions and experiences. These opinions and experiences were supplemented by literature using MEDLINE as the primary database for papers published between December 2000 and December 2013.

People with CVD who become depressed are more likely to stop taking their medicine and stop working with their health care worker. Most people with heart and mood problems live with their families. Health workers could have a role in supporting families living with heart and mood problems to their care and treatment. The paper has highlighted the importance of working with families living with heart and mood problems to help them to stick with care and treatment.

Most people with heart and mood problems live with their families. The paper has highlighted the importance of working with families living with heart and mood problems to help them to persevere with care and treatment. MHN may have a role, though consideration should also be given to exploring the role of other health care workers and members of the community. As the population ages, clinicians and communities will need to consider the impact of depression on adherence when working with families living with CVD and depression.

The long-term financial stability of hospital systems represents a “grand challenge” in health care. New ownership forms, such as private equity (PE), promise to achieve better financial performance than nonprofit or for-profit systems. In this study, we compare two systems with many similarities, but radically different ownership structures, missions, governance, and merger and acquisition (M&A) strategies. Both were nonprofit, religious systems serving low-income communities – Montefiore Health System and Caritas Christi Health Care.

Montefiore's M&A strategy was to invest in local hospitals and create an integrated regional system, increasing revenues by adding primary doctors and community hospitals as feeders into the system and achieving efficiencies through effective resource allocation across specialized units. Slow and steady timing of acquisitions allowed for organizational learning and balancing of debt and equity. By 2019, it owned 11 hospitals with 40,000 employees and had strong positive financials and low reliance on debt.

By contrast, in 2010, PE firm Cerberus Capital bought out Caritas (renamed Steward Health Care System) and took control of the Board of Directors, who set the system's strategic direction. Cerberus used Steward as a platform for a massive debt-driven acquisition strategy. In 2016, it sold off most of its hospitals’ property for $1.25 billion, leaving hospitals saddled with long-term inflated leases; paid itself almost $500 million in dividends; and used the rest for leveraged buyouts of 27 hospitals in 9 states in 3 years. The rapid, scattershot M&A strategy was designed to create a large corporation that could be sold off in five years for financial gain – not for health care integration. Its debt load exploded, and by 2019, its financials were deeply in the red. Its Massachusetts hospitals were the worst financial performers of any system in the state. Cerberus exited Steward in 2020 in a deal that left its physicians, the new owners, holding the debt.

The purpose of this paper is to examine an operational process through the use of a clinical practice improvement method to implement clinical pathways in the Amber Hospital's (name changed for privacy reasons) cardiology unit. This quality framework has been adopted as a means of preventing adverse events, to ensure quality of care is provided to all patients.

A quality assurance case study approach was adopted along with the clinical practice improvement method – a framework that allows continuous quality improvement to be applied in a practical way to clinical processes, in order to improve delivery of care. The clinical practice improvement method is broken into five cycles: project, diagnostic phase, intervention, impact, and sustaining improvement. The paper explains these cycles, demonstrating how each was achieved.

The clinical practice improvement method at Amber Hospital was found to provide superior performance in the clinical pathway allocation process and improved patient care. Having an appropriate and effective action plan involving clinical pathways helps to prevent service hindrances that may have adverse impact on hospital management processes leading to adverse events. The Amber Hospital case study has not only identified the physical constraints but also the constraints in relation to organization policies and operation procedures.

The paper highlights the need for organizations to have a “no blame” culture, which acknowledged that errors do and will occur. However, it is also recognized that it is important to have reliable data collection on these errors, in order to reduce the frequency and severity of adverse events. Lack of available data was a severe limitation.

The practical aim of this project was to improve recommended drug treatment in patients with Acute Coronary Syndrome through the implementation of clinical pathways. The author also wanted to measure the utilization rate of these pathways. While there were four pathways implemented, the majority of patients were allocated to pathway 1B. Hence, data were collected on those specific patients.

Quality operational framework, using a clinical practice improvement method, demonstrated how clinical pathways for Acute Coronary Syndrome were implemented successfully at the Amber Hospital. The report provides evidence that through conducting a CPI project, quality improvements were made in recommended drug treatment for patients diagnosed with Acute Coronary Syndrome, and to correct pathway allocation.

Telehealth consultations are likely to continue while living with COVID-19 and the risk of other pandemics. Greater understanding of patient perceptions is important in order to inform future integrated care models involving telehealth.

An interpretative qualitative study. Fifteen, in-depth qualitative interviews were conducted with diverse range of community dwelling patients who attended outpatient clinics at The John Hunter Hospital, Newcastle. Data were analysed using an inductive thematic approach.

Key themes were identified: (1) telehealth is valuable in a pandemic; (2) telehealth accessibility can be challenging; (3) there are variations in care experiences, especially when visual feedback is lacking; (4) telehealth for acute and complex care needs may lead to gaps and (5) considerations towards the future of telehealth, beyond a pandemic.

There is a shortfall in evidence of the patient experience of integrated care within a telehealth framework. The results provided practical insights into how telehealth services can play a greater role in integrated care.

Apart from the need for affordable access to high-speed data for basic Internet access, the author posit the need for patient and clinician training towards promoting communication that is underpinned by choice, trust and shared decision-making.

Telehealth is important towards keeping patients safe during COVID-19. Key findings extend knowledge of the practical implications need to promote integrated telehealth systems. While there is a benefit in extending telehealth to more preventative activities, there is also a need for greater service coordination and sharing of information between treating clinicians. Overall the results highlight telehealth consultations to be an effective means of treating well-known conditions and for follow-up rather than for acute conditions.

The persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France.

Data were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015–2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations.

Despite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted “patient safety”, a paradoxical injunction to do more with less and conflicting organizational priorities.

This paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes.

This paper aims to investigate the dyadic relationships of actors engaged in public–private (P-P) collaboration in health-care prevention. The purpose is to characterize a new type of actor as an intermediary that connects different actors in P-P collaboration and to compare P-P collaboration based on results expected with and without the inclusion of this new actor.

For the investigation, the Industrial Marketing and Purchasing Group approach to business relationships is used. The substance (activities-resources-actors) and the functions (dyadic, single actor and network) of business relationships are applied as a research framework. The analysis is based on these theories through a case study.

This study delivers four important findings: the relationship with this new type of actor results in new resources for all of the participants that are involved, the new actor is a key channel for generating corporate social responsibility recommendations for private actors, relationships with this new type of actor are a great basis on which private firms may build relationships with the public that involve higher levels of health care and also generate sponsorship for public causes, thereby increasing social welfare and the new type of actor can cause potential tensions that require constant and coordinated management.

The paper contributes to the conceptualization of the “interacted actor” through characterizing a new type of actor and its renewing network in P-P collaboration.