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Our Services

We are a consortium of experienced professionals engaged in establishing, restructuring, financing, operating and managing new and existing hospitals throughout the world.

1. Developmental Services

2. Operational Management Services

DEVELOPMENTAL SERVICES

The Consulting Services provided by DKP , during the Developmental stage of the hospital are completed in three stages:

1. MAFF
2. Resource Development
3. Commissioning

MARKET ANALYSIS & FINANCIAL FEASIBILITY

The stage involved while conducting MAFF, are as follows:

Understanding the Vision:

The process of creating a Hospital in the private sector is a challenging process. It begins with a series of one to one discussions with the representatives of the entrepreneurial organization. Through these dialogues, and via questionnaires designed to ensure systematic review of the various options and directions available, DKP attempts to understand the organizational philosophy and the short-term & long-term goals to be achieved.

Population Analysis: Private Sector Target Market.

Evaluation of the target population is carried out with a scientific assessment of the catchment areas of the hospital. This process takes into account the traveling time at different times of the day, the demographic characteristics of the target population, the paying capacity of the primary and secondary target population, evaluation of the potential international client mix, etc.

Incidence of Disease:

The incidence of disease in a target area is an important, and yet frequently difficult parameter to find in developing countries. The data provided by the State and Central Govt. Health Departments is frequently incomplete and flawed. It rarely breaks up the disease patterns by income criteria, a parameter important to determining the actual number of people who have the paying power for a top grade private hospital. Even if the institution were to provide certain amount of subsidized care for the economically less fortunate members of the society, the need for finding those patients who will support that subsidization, is clear. DKP uses proprietary techniques to overcome these limitations in the national data, and to create reliable and reproducible estimates of the incidence of disease by various relevant parameters.

Patterns of use of Healthcare Services by the Target Market:

Determination of the pattern of utilization of healthcare services in a target population is a function of the incidence of disease, the various demographic parameters, such as; age distribution (e.g. childbearing vs. postmenopausal female population may present an entirely different need for services), proximity to highways, availability of specialists of a truly international fame, unique specialties offered by an institute, etc.

Why people use a particular healthcare center, or a particular doctor is often a matter of personal choice, but sometimes, it may simply be lack of availability of a better choice. These become important factors in determining which patient population is open to new choices.

When dealing with a Tertiary Care Institute, many patients are seen as referrals from other doctors in the community being served by the hospital. Determining the level of support from this group of healthcare professionals is important. In your country, there is common practice of providing economic incentives to the referring doctors. The evaluation process is designed to determine the type, quantum, desirability and various alternatives to getting this referring-physician support.

Private Sector Competition:

There are several private hospitals in the area. After performing a detailed analysis of the population-base in the primary and secondary catchment areas, and based on the location of the proposed institution, we evaluate the availability of various services offered by other hospitals in the proposed catchment area. Our proprietary systems allow us to analyze the competition from the standpoint of variance from the internationally accepted benchmarks. The quality, uniqueness, strength, weakness and deficiencies are assessed. The process looks both at the Facilities and the Human Resources. A patient satisfaction index is created from the patients using the competitor facility.

Physician Profile and Medical Specialty definition:

Once the pattern of disease, the target population characteristics, and the strengths & weaknesses of the competition have been accurately determined, it becomes possible to short-list the Specialty-Mix that would be appropriate for the hospital. The critical issue in the final selection from this shortened list is the availability of the right type of Medical Staff for the proposed specialty. The medical staff in the selected specialty has to be more then one layer deep, so that the departure of a single specialist does not weaken the department. Where needed, internationally recognized specialists may have to be selected from across the globe.

DKP arrives at the appropriate number of doctors and other healthcare professionals based on the Graduate Medical Education National Advisory Committee recommendations and duly factoring in the efficiency and productivity of the medical professionals in the local market.

DKP assists the management in developing the skill, experience and personality profile of the person, or persons to be selected for heading the important clinical departments. As an additional optional service, DKP may extend this profiling to other members in the healthcare hierarchy.

Skill Assessment of the Local Healthcare Professionals:

Healthcare technologies have become extremely sophisticated, and technically complex. It is extremely important that the skill level of the local healthcare provider is accurately evaluated. This factor is important at all levels of healthcare-team hierarchy, ranging from the housekeepers to the chairman of the department. It is an unfortunate fact that most graduate Nursing Schools, Medical Colleges, and Medical Technology Colleges in your country were not able to provide their graduates with sufficient exposure to technology that is generally used in private Tertiary Care Hospitals. These individuals have the theoretical knowledge, usually drawn from textbooks, which by their very nature contain information that is two to three years old. These graduates are otherwise bright, but need considerable time and exposure to the latest tools before they can master them.

As an additional service during the resource development phase of a hospital development process, DKP evaluates the individual and category skill- levels of the local healthcare providers. Our ‘Friendship Team?of International Specialists can be activated, not only for setting up of the various departments, but also for upgrading the technological skills of the local healthcare provider. This can save the institute large amount of expenses in hiring high cost professionals.

Hospital Operating Expenses:

Determination of a Synergistic Medical-Specialty-Mix to be offered at the Tertiary care Hospital determines the capital-costs and the operating expenses. Availability of local profession skill also affects the human resource costs. Once these factors have been evaluated, DKP systematically determines the operating costs on the basis of the various fixed and variable operating costs.

Physician and Hospital Pricing:

Determination of the compensation paid to the healthcare delivery team is based on the prevailing market rates, the uniqueness of the professional skill, the reputation of the healthcare team member, and the philosophy of the entrepreneur. Hospital pricing, again, requires evaluation of the market rates for a given service, the reputation of the institution & the healthcare delivery team, and the uniqueness of the service being offered. DKP calculates these various factors before suggesting a price for the specific service.

Market Rates Determination:

DKP has developed methodologies to calculate the actual cost and profitability of various procedures. In any service offered at the institute, there are going to be certain loss makers to support the profit centers. Proper analysis of the market rates requires detailed knowledge of the exact package of services included in a given "global fee". As for example a stated fee for a given procedure may still leave additional charges to the patient at the time of discharge. This generates a negative impact on the patient and the relative, and thus the reputation of the Institute. DKP evaluates the precise cost of a given treatment, using an ?apple and apple?comparison, before recommending the appropriate charges for the service.

Evaluating the Local Referral-Fee Systems:

Payment of referral-fee to the referring doctor appears to be a common practice in your country. This is generally not done in the Western countries, and alternative methods have to be developed for dealing with this issue. Depending on the philosophy of the entrepreneur, DKP can propose several alternative scenarios.

Utilization: Existing and Projected:

Evaluation of the current utilization of healthcare services in the targeted market-areas is crucial in determining the size of the hospital, the number of beds created, the percentage of resources allocated to each specialty, the specialties with the highest demand and the size and nature of the support facilities. DKP proposes development of innovative methods to introduce services that will keep the utilization of the services at the proposed institute, at a desirable level.

Government Regulations:

Understanding the various governmental rules is important, not only for issues that affect the hospital operations, but also such factors that have an impact on the environment, the community acceptance of the project, and structural issues. A high grade Tertiary Care Institute is in a unique position to create an over all community and governmental goodwill. DKP can suggest methods to achieve this objective.

Healthcare Services Financial Data:

Once all the information has been collected, DKP arranges follow-up discussions with the representatives of the entrepreneur to determine the final mix of services to be offered at the hospital. Based on the data and the business philosophy of the organization, a detailed financial analysis is prepared. The financial information is presented using internationally accepted accounting procedures.

Wage and Hour Labor rates:

Based on the market realities, DKP develops a wage structure for the institution. The process includes determination of work force requirements at each departmental level, and the compensation at which each skill-level is paid. The organization is given various methods by which high-value staff is included within the hospital.

Strategies to Blend ‘Profit-Centers?with Other Goals:

The Hospital must develop strategies to create Profit-Centers that will support the hospital, not only to give the investor a decent rate-of-return on his/her investment, but also generate revenue surplus to support the needed up-gradation of the equipment and technology. This revenue generation has to be balanced and broad based, for all the burden cannot be placed on the direct patient charges. As an optional service, DKP can recommend strategies, and propose scenarios that would create ongoing revenue flows for the Institute.

2. RESOURCE DEVELOPMENT

DKP develops detailed plans, manuals and programs necessary for preparing the hospital for the Pre-Opening Stage. The overall intent during this stage is to position the Hospital for obtaining, in the future, accreditation by JCAHO/JCI.

The key result areas to be addressed include the followings:

Architectural Services

DKP assists architects in establishing the 'Sizing Model' or space program on a room-by-room basis. The Sizing Model takes into account programmatic and functional needs as they relate to room size; this includes the basic equipment; circulation; structural, mechanical and electrical space requirements, and staffing patterns and space needs. Space needs are also established and tested against current utilization trends and patterns as reviewed in MAFF.

Management Information System (MIS)

The service commences with making a RFP for the Project Leader, and development of user specific MIS during the project implementation, and commissioning stages.

Equipment Plan

The activities developed during the stage are Budgeting, Specification Development, Architectural and Engineering Support, Inventory need Assessment, Procurement management (including AMCs), and the installation / relocation planning.

Contracts Administration

Evaluation and creation of legally binding contracts for all Services and Technology contracting activities, either through direct internal or external resources, or through the procurement process is carried out.

Wages & Benefits

Evaluation of regulatory and competitive environment, determination of positions by department and shifts, development of job descriptions, development of wage and benefit program, and setting up of performance evaluation systems are systematically carried out.

Recruitment (Support & Technical Staff)

The scope of service includes identification of government and regulatory requirements, assessment of local resources, establishment of recruitment calendar, and development of personnel contracts/agreements.

Employee Orientation

Development of hospital-wide orientation program is developed for the employees at all levels; employee handbooks are created.

Physician Plan

Development of medical staff by–laws, rules and regulations; development of wage and benefit package; the physician contracts and agreements are carried out. The physician recruitment calendars and rotational plans are drawn. The fee schedule and billing procedures are established.

Government Codes & Compliance

The applicable operating codes/regulations issued by various government ministries are identified for incorporation into all legal documents.

Marketing Plan

The identification and development of promotional programs is carried out. Advertising agencies are identified and business relationships are formulated. DKP develops the template for the marketing budget, and also the strategy for contracting with corporate accounts.

Policies & Procedures

Development of administrative manuals, and development of preliminary and detailed policies and procedures for all hospital departments is carried out. Systems are developed to review and revise the policies and procedures manuals as and when necessary, based upon equipment specifications, patient flow, MIS and cultural requirements.

Risk Management

All aspects of risks, operational contingency plans, legal liability, political / regulatory risks, and financial / market risks are analyzed for determination of the Insurable, Claimable and Non-claimable risks.

Materials Management

Research and identification of the government and regulatory requirements, assessment of the local market for source of supplies and pharmaceuticals, and obtaining of price quotes for selected supplies & pharmaceuticals, is carried out. Strategic relationships are developed with the selected vendors to ensure dependable supplies and competitive rates. The system for replenishment, and inventory methodologies, such as ABC (Always Better Control), VED (Vital, Essential and Desirable) criteria and EOQ (Economic Ordering Quantity) etc, are implemented.

3. COMMISSIONING

Implementation of the plans established in the resource development stage is carried out. This stage entails ensuring that the opening of the healthcare facility occurs as timely and efficiently as possible. Enhancing the level of acceptance of the healthcare facility through the marketing and promotion of the facility also takes place during this stage. The key areas addressed during this stage include:

Evaluating the need of overseas specialists:

A Hospital needs very high caliber of doctors and other professional staff. The type of high paying patient, that the hospital needs to attract, is generally aware of the type of procedures, and services available in the advanced countries. Therefore, it becomes important to determine the level of professional skills, and treatment methodologies used by the doctors at the institute. If the level of skill does not match the talent that the patient is expecting, then the institutional reputation is compromised. In these situations, one needs to consider overseas healthcare specialists. DKP is able to identify such talent, and negotiate arrangements for their working at the institute.

Our experience at other institutes in the developing countries has prepared us for determining the most economical routes for the institute.

Creating a rotating schedule of overseas staff:

Depending on the depth of the locally available talent, there may or may not be a need for creating a rotating availability of overseas professionals. If such a need is deemed necessary, then DKP arranges a cadre of professionals who come to work at the institute on a rotational basis. The selection of the professionals is made to maximize the diversity of individual talent, so that the local medical staff is able to expand their knowledge base and repertoire of procedures and techniques.

Recruitment and training of local staff:

Selection of the professional staff is done on the basis of individual skill level, rather then their degrees or letters of recommendation. DKP uses a highly developed, proprietary credentialing method to select the technical and physician staff. The process is designed to evaluate the potential candidates for their current experience, skill level and functional performance abilities for the position for which he/she is being considered. In addition, the process assesses their aptitude for working in the type of tertiary care hospital envisaged by the entrepreneur.

The non-medical staff is also selected with many of the above issues in mind. Their ability to function within an organization that places high demands for efficiency, productivity, accountability and functioning above a benchmarked level are thoroughly scrutinized.

Installation of the medical equipment:

The equipment installation process requires complete understanding of the entire resource development and implementation process. The equipment has to be shipped from the manufacturer at the correct time, so that the site is ready for installation; the personnel to install the equipment are able to accomplish their task within the allotted time frame; the local staff are adequately selected and trained; and there is a pre-selected date for active use. DKP closely supervises the process from the equipment planning, to the active implementation.

Calibration and testing of the high-tech medical equipment:

Once the equipment has been installed, the process of calibrating the equipment is meticulously carried out. The machines are subjected to mock drills, and the quality assurance systems are implemented. The selected professional staffs are given on-the-site didactic and practical training for each of the machines. The selected staff practices Trouble-Shooting techniques. A simultaneous process of evaluating the staff aptitude and deficiencies is started. Where needed, additional training is provided. Manuals for proper calibration techniques, equipment maintenance schedules, and technician duties towards the equipment are implemented.

Medical Staff Recruitment:

Through a combination of open advertisement in prestigious Medical Journals, and other international selection methods available to DKP, the Medical Staff selection process is started. The identified individuals are subjected to a vigorous credentialing procedure. Whether the staff is going to be a full time employee of the hospital, or associated with it through Independent Consultant arrangement, the process ensure that the people chosen are able to perform the roll for which they are being selected. There profile is created and a confidential dossier is made to evaluate such performance parameters their activity costs, morbidity and mortality rates, patient satisfaction index, efficiency index, and productivity index.

Development of the Local Office Management Staff.

The selection process for the management staff is carried out with similar details in mind. The selected staff is instructed in the use of international operational norms. They are familiarized with the technology-based systems for gathering the patient information for clinical, billing, accounting and medical record purposes. Procedure manuals are implemented and the reporting mechanisms are implemented. DKP ensures a full understanding of the senior management philosophy by the office management team.

Develop Materials Management Protocols.

Material management, inventory control, purchasing protocols, control of central and unit supplies, pharmacy controls, controlled substance management, medical-gas supply, etc require rigid protocols. Even in the best circumstances, a certain amount of waste, pilferage and outright theft have been reported. The current material management protocols designed specifically for hospitals have been able to reduce these losses to a minimum. DKP has been at the forefront of development of such systems, and ensures proper implementation of the protocols.

Nursing and Technical Education.

The nursing and the technical staff trained in your country have very limited exposure to the sophisticated technology of today. Even those staff that have previously worked in the better private hospitals, may not have worked with the machines of today. Training the staff to be able to function in this new environment requires evaluating their existing skill and abilities, and implementing the program to upgrade their skill in proper use of the tools, and learning to assist the specialists with the new procedures. DKP takes an active roll in the baseline evaluation and development of the best techniques for the training process.

Start-up of the Operations.

Once all the human resources have selected and trained to the required level, and the equipment has been installed, the institute is made to rehearse through a series of dry runs, before active patient care is started. During this time, all the bugs in the system are closely monitored and corrected. The staff is made to follow the procedures like a ‘second nature? Active marketing, community awareness about the institute, the services offered, and the virtues are highlighted. Depending on the philosophy of the management, the institute could be started in a staggered manner, or all activities could start at one time.

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B. OPERATION AND MANAGEMENT

A well planed, and properly designed hospital has a high potential for success, but to realize that success, one needs to manage the institution by using the experience and knowledge on the one hand, and the technology tools that can yield the highest level of efficiency and productivity, on the other. The Medical Staff is a high-value commodity that must be utilized efficiently to get the highest return on the entrepreneur’s investment. A recent Price Waterhouse study shows that even in countries like USA, nearly 40% of the doctor’s time is wasted in unproductive pursuits. Through a series of steps designed to understand the bottlenecks and the low yield areas, DKP is able to recommend the operational methodologies to improve the financial and performance outcome.

Services offered during the Operation and Management Stage of the project, include the following essential-result areas:

Administration

Direction, Coordination and Supervision is provided to the main executives, who are responsible for the day-to-day operations of the hospital. Systems are introduced for setting up of Standardized Procedures for Internal Controls, Budgetary Controls, Financial Planning and Management, Compliance of Acts / Regulations, Tax Planning, Management Information, and Cost Control measures.

Benchmarking

Establishment of Benchmarks is essential to monitoring the individual, departmental and Institutional performance. DKP establishes an internal base line data for comparison with external benchmarks. Mapping and measurement of the process is carried out for most critical parameters to optimize the factors that are critical for the stakeholders, is carried out using a systematic and scientific methodology. Using comparison with external benchmarks, gaps are identified in the performance parameters, and remedies found.

Physician Recruitment

An on going process of physician assessment, credentialing, technique-screening, productivity analysis, cost-per-procedure analysis, complication rate, length-of-stay analysis / physician, etc. are carried out. Locum tenens are evaluated, and vacation coverage for the staff is arranged.

Friendship Team Rotation

Where indicated, a rotation schedule is created for the Friendship Team. The local licensing is arranged for the selected medical Sub Specialists who comes from abroad. DKP organizes the smooth performance of the overseas team. Many of the members of the Friendship Team have international reputations. DKP organizes continuing medical education opportunities for the local staff, while these renowned individuals are at the institute.

Operations

As a part of an on going effort to improve efficiency and performance, periodic departmental audits are carried out. The deficiencies are recognized and methodologies to correct the problem are developed. Quality Assurance protocols for optimal patient care, and operational plans are audited. Improvement plans are implemented based on these audit results.

Nursing Management & Education

Clinical protocols used by DKP have been developed using “American Standard?for providing care. Nursing staff performance is evaluated on the bases of variance from these Standardized Nursing Care Protocols used in USA. Continuing education is provided when the staff is found deficient in particular skills.

Utilization And Quality Assurance

The nursing staffs, as well as the specially trained Utilization and Quality Assurance Personnel, routinely collect data, which includes utilization review & quality assurance parameters. The information is used to evaluate the cost and outcome analysis of the activities, and assess variance from established benchmarks.

Materials Management

Through a process of continually assessing new advances in the supplies, pharmaceuticals, instruments and equipment, and an on going process of analyzing new medical technology, DKP develops equipment replacement plans for obsolescent medical systems, and prepares investment analysis for such equipment.

All vendor contracts are updated annually, and DKP seeks annual cost bids from various national and international suppliers.

Human Resources

DKP does screening, assessment, credentialing & contracting for all nurses, technicians and the ancillary staff. Using the proprietary system developed by DKP, SKILL-ASSESSMENT-ANALYSIS is done on each potential employee. A benefits package is created on the basis of this analysis program. All personnel are given a Professional Skill Enhancement Target at the time of employment. This is assessed at the anniversary of the employment date. The process of constant updating of the personnel is maintained and recorded.

Management Information Systems

The Management Information System is operated with the purpose of overall system support & institutional operation review. The Drill Down Capabilities, and the Decision Support System ensure appropriate trouble shooting through a process of on going in service.

Financial Services

DKP follows the international procedures for production of the appropriate Financial and Management reports. The Benchmarking and Productivity audits ensure highest level of efficiency and performance by the individual departments.

The Operating and Capital Budgets are prepared annually and presented to the Hospital Board for approvals. Analysis of the budgetary performance is done through internal and system audits.

Fiscal Development process is carried out as needed.

Planning, Marketing & Business Development

Strategic planning is done annually. Where needed, in light of technology advances, updating of the capital equipment is planed. Plans are developed to enhance the Image of the hospital and where appropriate, direct contracting with business houses & industrial units is carried out. DKP continually updates it’s market research and marketing plan.

Accreditation With JCAHO/JCI

DKP arranges the survey for Provisional Accreditation, once the appropriate operational procedures have been implemented and the performance data has been collected. Where needed, corrective action plan are prepared.

After the initial Accreditation, the continuation and compliance of the JCAHO / JCI requirements and other related formalities is continued.