AMALGAMATION OF THE ‘EST’ OF INDIAN SKILL SET & … Procurement Business Model by... ·...
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AMALGAMATION OF THE ‘BEST’ OF INDIAN SKILL SET & JAPANESE QUALITY HEALTHCARE
Transcript of AMALGAMATION OF THE ‘EST’ OF INDIAN SKILL SET & … Procurement Business Model by... ·...
AMALGAMATION OF THE ‘BEST’ OF INDIAN SKILL SET & JAPANESE QUALITY HEALTHCARE
ABOUT SAKRA
Sakra World Hospital is India’s first MNC Hospital.
A joint venture between Kirloskar Group, Toyota Tsusho, and Secom Hospitals - ‘SakraWorld Hospital’ combines synergies of these large entities to provide the cutting-edgemedical technologies and herald a change in the current healthcare systems & processes.
Dedicated to ensuring good health of the community, Sakra is targeting over 20,000 potential beds in thecoming years.
Sakra World Hospital offers state-of-art infrastructure with India’s first bi-plane hybrid OT, latest 32-sliceintraoperative CT Scanner and Neuro-Navigation system, 11 integrated modular OT’s and we are also in theprocess of starting Tele-ICU.
ABOUT SAKRA
Place of Healthcare Technology Management in the Health System
Place of Healthcare Technology Management in the Health System
Medical Equipment
Medical Equipment procurement
Plan
BudgetSelect
Schedule
Procure
ScopeBidBuy
Place
CoordinateDeliverInstallTrain
Transition
ReportsPatients
Equipment
Four Pillars of Procurement System
Reg
ula
tory
Fra
mew
ork
Inte
gri
ty &
Tra
nsp
are
ncy
Inst
itu
tio
na
l an
d M
an
ag
emen
t C
ap
aci
ty
Op
era
tio
ns
& M
ark
ets
Complexity of Medical Equipment Procurement Process
Medical Equipment
Procurement
Clinicians Desire
Limitation/Desire of
Management
Need of the organization
Medical Program
Gather reliable information about equipment
Plan technology needs and allocate sufficient funds for them
Purchase suitable models and install them effectively
Provide sufficient resources for their use
Operate them effectively and safely
Maintain and repair the equipment
Decommission, dispose, and replace unsafe and obsolete items
Ensure staff have the right skills to get the best use out of your equipment
Upgradation of Medical Program
Guiding Principles at every level
Equipment procurement with focus on Japanese way of working
Equipment Procurement
Policy & Process
Designing
Policy Deployment
Planning and Need
Assessment
Technology Assessment
Procurement
Monitoring
Policy & Process
Designing
Kouteihyou - Establish Process map
This process mapping for procurement to avoid Muda i.e.
waste, Muri i.e. non value addition & Mura i.e. unevenness
Responsibility Medical Services
User Department
Clinical Engineering
Safety
standard Facility Engineering
considerations Clinical Engineering
Information from Clinical Engineering
exhibits,colleagues, Purchase Department
& literature search Medical Services
Yes
No
Clinical Engineering
Medical Services
Purchase Department
Technical-Clinical Engineering
Commercial-Purchase
Purchase committtee
(End User,Management,Finance,Purchase,
Medical Service,Clinical Engineering)
Purchase Department
NABH National Accrediation Board For Hospital
RFP
FMS
Process Name :
Medical Equipment
Purchase Content of process
The various steps in
medical equipment Purchase
Reference: NABH FMS 4 Process Category: Macro
Process Type: Clinical Cross Reference:
eBME,UK &Management
of Medical Technology-
Bronzino
Abbreviation
Request for proposal
Facility Management System
Clinical personnel initiation
Defination of Clinical requirement
Assessment of environmental conditions
Survey of avilable and existing equipment
Preparation of system specifications
Start
End
Solicitation of RFP/proposals/bids
Proposal & Bid evalauation
Buy " off the shelf"
Vendor selection
Issue of purchase order
Policy Deployment
Hoshin kanri :Policy deployment : Participative goal setting process with all stakeholder
Big picture plan for year is broken down level by level until it is clear to
every member of hospital
Policy Deployment
Kyoudou Sagyou - Team practice is integral part of procurement activity
SnoMembers in medical equipment
procurement Role in procurement
1 Clinical User
Clinical Requirement
Survey of available equipment in market
Part of techno-clinical evaluation
Part of negotiation with vendor
2 Clinical Engineering
Building technical requirement based on clinical requirement
Survey of available equipment in market
Input on environmental conditions along with facility engineering
Part of techno-clinical evaluation
Part of negotiation with vendor
3 Medical Services
Need analysis of particular clinical requirement on overall medical services offered by
Hospital
Survey of available and existing equipment
Preparation of system specifications
Part of negotiation with vendor
4 Purchase Department
Survey of available and existing equipment
Solicitation of RFP/proposals/bids
Proposal & Bid evaluation
Lead negotiation with vendor
Issue of purchase order
5 Finance Department
Allocation of funds & cash flow
Part of negotiation with vendor
To analyse Break-Even,Payback,NPV for equipment
6 Management
Approval of Clinical Requirement after getting input from Medical Services ,Marketing &
Finance team.
Part of final negotiation with vendor
Formation of capital equipment selection committee
Planning and Need
Assessment
Nemawashi - Make decision slowly by consensus but implement it rapidly
Establish timeline –Gantt ChartYear &
Month2012 2013
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
Med
ical E
qu
ipm
en
t
Equipment Planning (1 )
Vendor Meeting(2)
Technical Specification(3)
Negotiation
(4)
Purchase
Order(5)
Delivery Lead Time
(6)
Installation/Commission
(7)
Planning and Need
Assessment
Guiding principles for selecting equipment
Need
Appropriateness
Quality
Costs
Source
Use and maintenance 8 Material
Disposable or reusable8 Material
Planning and Need
Assessment
Capex Budget Planning
TAKSHASILA HEALTHCARE & RESEARCH SERVICE :MEDICAL EQUIPMENT PLANNING
AREADEPT TYPE ITEMS Unit Cost
Phase 1
Qty
Phase 1
cost
Phase 2
qty
Phase 2
costTotal Qty Total cost Remarks
LAB Lab EquipmentAuto Analyzer Random access -Biochemistry 0.00 1 0.00 0 0.00 1 0.00 Reagent & Rental basis
LAB Lab EquipmentSemi Auto Analyser -Biochemistry 0.00 1 0.00 0 0.00 1 0.00 Reagent & Rental basis
LAB Lab EquipmentAutomated Haematology Analyser 0.00 1 0.00 0 0.00 1 0.00 Reagent & Rental basis
LAB Lab Equipment Automated Hormone Assay 25.00 1 25.00 0 0.00 1 25.00
LAB Lab Equipment Automated Blood & Fluid C&S 30.00 1 30.00 0 0.00 1 30.00
LAB Lab Equipment Automated Elisa Reader 5.00 1 5.00 0 0.00 1 5.00
LAB Lab Equipment Urine Analyser 2.50 1 2.50 0 0.00 1 2.50
LAB Lab EquipmentAutomated Histopathology System 35.00 1 35.00 0 0.00 1 35.00
LAB Lab EquipmentMicroscope with 10 x, 40 x and 100x Objective. 0.70 5 3.50 2 1.40 7 4.90
LAB Lab Equipment Centrifuge local 0.25 4 1.00 2 0.50 6 1.50
LAB Lab Equipment Centrifuge Imported 1.25 2 2.50 1 1.25 3 3.75
LAB Lab Equipment Blood Gas Analyser 5.00 1 5.00 0 0.00 1 5.00
LAB Lab Equipment Coagulometer 2.00 1 2.00 0 0.00 1 2.00
LAB Lab Equipment Deep Freezer 0.20 1 0.20 0 0.00 1 0.20
LAB Lab Equipment Microscope -Histopath 1.75 2 3.50 1 1.75 3 5.25
LAB Lab Equipment Incubator/Hot air ovan 0.10 3 0.30 2 0.20 5 0.50
LAB Lab Equipment Medicine Refrigerator 0.12 2 0.24 1 0.12 3 0.36
LAB Lab Equipment Laminar Hood 0.75 2 1.50 0 0.00 2 1.50
LAB Lab Equipment Safety Cabinet 1.75 1 1.75 0 0.00 1 1.75
LAB Lab Equipment Autoclaves 2.00 1 2.00 0 0.00 1 2.00
Capex Budget planning even considers facility plan besides
other factors like strategic plan
Sakra World Hospital
Technology Assessment
Hourensou :Management team keeps in touch with what is going on i.e. Understand current
technology
Visit to medical equipment fair, international hospitals & vendor’s office to know about
best available medical technology
Technology Assessment
Meeting potential vendors to understand the technology & shortlisting vendors
Equipment Pre-Bid meeting with all major vendors with Sakra World
Hospital team members including Clinical Engineering, Medical Services, Engineering & management executive.
Technology Assessment
Finalization of technical specification for equipment & scope of supply
Technology Assessment
Technical evaluation
Annexure1:TECHNICAL SPECIFICATION for MRI SCAN MACHINE 1.5T
Sr.N
oFeatures
1 Make THRSPL MAX GE Hitachi PHILIPS SIEMENS
2
Model OPTIMA
MR450WEchelon Oval Ingenia 1.5T
MAGNETOM
AERA
3
Specify whether the Model is Top of
Line(Yes/No)
Yes Yes YES YES
4
Model offered to be brand new(not
refurbished)(Y/N)
Yes Brand New Yes YES YES
5
Is model FDA approved?
THRSPL 10
Yes FDA approved
10
Yes
10
YES 10 YES
10
7
Principal Company Name
GE
Hitachi Medical Systems (S)
Pte Ltd PHILIPS SIEMENS AG
8
Country of origin
USA Japan NETHERLAND GERMANY
MAGNET
9
Type(Ultra-compact, Superconducting,
Active shielded magnet)
Yes
Superconducting Actively
Shielded magnet
Ultra-compact, Light
Weight uperconducting
Magnet
Ultra Short,
Superconducting Magnet,
patient-friendly design,
high homogeneity. 1.5
Tesla with 70 cm Open
Bore design. Easy siting
due to AS (Active
Shielding) and E.I.S.
(External Interference
Shielding) magnet
technology
10
Max FOV(cm)THRSPL 10
50CM7.5
50cm7.5
55cm 10 500 mm7.5
12
Length (meters)10
1.45m10
1.79m 7.5 1.5m 10
1.37 meter ( 1.45 meter
cover to cover 10
14
Weight ( Kgs)THRSPL 10
3692Kg10
5200kgs7.5
3060Kg 10 3118 kg (with cryogens)10
43
Bandwidth
THRSPL 10
1MHZ
10
500KHz
5
720 kHz 10 800 kHz
10
GE 312 Hitachi 280 Philips 309 Siemens 313
MRI 1.5 T
Sno Model 1 Model 2 Model 3 Model 4Important installations
GE
Discovery MR450W(2010)/2
HDXC(2009)/300+(include upgrade of HDX)
MR360(2010)/30
MR355(2010)/80
Manipal ,St.John,NIM
ANS,70 cm/32/44
60 cm/16/33
60 cm/8/33
60 cm/8/33-No Cardiac
Hitachi
Echelon Oval Echelon
72 cm/16/38
61cm/8-16/33
Philips
Igenia(2012)/13
ACHIEVA (2005)/108 Apollo
Hospital,Vijaya,Bhsarta
scan
70 cm/Infinite/33 & 45
60 cm/8-16/33 & dual
Siemens
Aera(2010)/6
Avanto(2004)/120
Essanza(2008)/115 NIMHANS,M
edicity,PGI70cm/48-64/33 & 45
60cm/8-18-32/33 & 45
60cm/8-16/30
Procurement
Release of Request for proposal ( Technical & commercial ) to shortlisted vendors
Proposed 350 Bed Hospital Bangalore
ProcurementSelection of Medical Equipment
The committee takes decision on procurement based on following broad criteria.Clinical rating by clinical team based on demo, clinical features etc.
Technical rating based on technical specification, vendor competency etc.
Commercial rating based on capital cost & life cycle cost, delivery & payment terms etc.
Non financial evaluation i.e. opportunity cost, overall hospital strategy.
Financial evaluation i.e. Break-even, payback, NPV analysis.
Monitoring
Visualization of procurement process monitoring activity at Oobeya room i.e. big room as control room
Close monitoring of procurement activity including delivery status against timeline by
management team
Monitoring
Visualization of procurement process monitoring activity at Oobeya room i.e. big room as control
room
Procurement Models Pros Cons Recommended Business Application
PurchaseAttractive payment terms, Deferred payment & early breakeven on cost is assured with high patient volume
Upfront Capital Expense, Difficult to replace technology frequently
At the start of the Hospital, equipment which is critical and is widely used across specialties should be procured by outright purchase. Equipment where high volumes are
expected as per the medical program mix, outright purchase is recommended
Lease RentalNo need to invest huge initial
capital
Hospital pays monthly amount plus premium of 10 to 20 % of original
value
High cost, low usage equipment where it takes time to build volumes can be considered at lease rental model.
Example: Navigation unit for Operating theatre
Pay per Use/Reagent Rental(Equipment either installed
in the Hospital and payment per use e.g.
Dialysis Machines)
No initial capital investment, Technology upgrade is possible
without additional cost, Pay for use based on per patient or fixed
monthly fee, No maintenance cost
The minimum guarantee sometimes can be more than the volume
generated and thus monthly cost is high
Recommended at the start of operations for select equipment like Chemistry analyzer
Not attractive when workload reaches beyond certain level
Procurement Models
Case StudyMRI 1.5 T
Input data
• Cost of the equipment CIF in equivalent Rs. 50,000,000/-
• Cost of the interior / infrastructure Rs 2,500,000/-
• Number of films per patients:2
• Cost per 14 x 17" laser film:Rs 90/-
• Charge per patient is excluding Contrast material
• Salaries considered for 1 No-Radiologist ,2-Radiographers(being shared with other modalities such as CT<US etc)
Basic assumption considered –Patient flow
Year 1 2 3 4 5
Basic assumptions on patient flow
Annual Volumes
Head 1450 1600 1720 1750 2000
Spine 1450 1600 1840 2000 2400
MRCP 400 500 550 600 640
MRA / MRS/DTI 600 600 650 680 710
Total 3900 4400 4800 5030 5750
Average daily throughput 12 14 15 16 18
Basic assumption considered –Operating cost
Operating costs
Year 1 2 3 4 5
Salaries 4,000,000 4,600,000 5,290,000 6,083,500 6,996,025
Service contract CMC 0 2,600,000 2,860,000 3,146,000 3,460,600
Electricity 3,400,000 3,570,000 3,748,500 3,935,925 4,132,721
Film cost 702,000 792,000 864,000 905,400 1,035,000
Conference/promotion 200,000 210,000 220,500 231,525 243,101
Stationary / Telephones 200,000 210,000 220,500 231,525 243,101
Miscellaneous 200,000 210,000 220,500 231,525 243,101
Rent 200,000 220,000 242,000 266,200 292,820
Total expenses. 8,902,000 12,192,000 13,424,000 14,765,400 16,353,650
Scenario 1: Outright purchase
PART A: PROFITABILITY STATEMENT
Operating costs
Year 1 2 3 4 5
Total expenses. 8,902,000 12,192,000 13,424,000 14,765,400 16,353,650
Revenue
Patient revenue as stated above 22,350,000 24,550,000 27,155,000 28,685,000 32,690,000
PBDIT (B-A) 13,448,000 12,358,000 13,731,000 13,919,600 16,336,350
Less Depreciation 7,500,000 7,500,000 7,500,000 7,500,000 7,500,000
Profit Before Tax 5,948,000 4,858,000 6,231,000 6,419,600 8,836,350
Scenario 2: Lease Rental
PART A: PROFITABILITY STATEMENT
Operating costs
Year 1 2 3 4 5
Total expenses. 13,702,000 17,212,000 18,466,000 19,831,600 21,446,470
Revenue
Patient revenue as stated above 22,350,000 24,550,000 27,155,000 28,685,000 32,690,000
PBDIT (B-A) 8,648,000 7,338,000 8,689,000 8,853,400 11,243,530
Less Depreciation 0 0 0 0 0
Profit Before Tax 8,648,000 7,338,000 8,689,000 8,853,400 11,243,530
Recommendation
Adhere to the set guidelines
Comprehensive procurement policies set the framework and expectations for open,
ethical and transparent procurement and enable boards and management to tell staff
their responsibilities and what is expected of them
Process of Negotiation should include apple to apple comparison of each specification
and cost
Be strict & ruthless on desire to bring best technology with cost effectiveness
Thank You
