Globally, the challenges of healthcare delivery vary widely, yet health systems around
the world have similar objectives :to deliver the highest quality care to the most people
possible at the lowest possible cost .Healthcare spending around the globe continues to
rise at unsustainable rates, consuming an ever -increasing slice of the world seconomy .
As measured by the percent of GDP healthcare, costs rose from 8.2to 9.4percent from
2000 to 2009 .The burden of chronic diseases is rising in both developed and emerging
markets, fastest among lower -income countries, populations and communities, where
they impose large costs in human, social and economic terms .
In response, the
worldwide healthcare industry is undergoing radical transformation, driven by a
fundamental shift in the expectations of all stakeholders :patients, governments,
insurers, employers and providers . Increasingly, healthcare delivery organizations
worldwide are rethinking the services they offer as funding and payment models evolve,
focusing on wellness and outcomes rather than volumes of services consumed .
transformation to succeed, organizations will need to adopt both technology and
process improvement strategies to enable secure access, exchange and analysis of
patient information and to create greater efficiencies in both business and clinical
processes .These strategies will give rise to amore patient -centric care model through
better monitoring and management of wellness and chronic disease and enable cost
containment while improving overall delivery system health .The evolving trends in the
Indian healthcare sector have increased the urgency of addressing these challenges .
Some of the major trends are more patient -focused care, value -vs volume -driven healthcare, continuum
of care and increasing digital integration .
Patients today are more conscious, tech -savvy and more
willing to embrace emerging technology .As aresult, anew trend has emerged, where the focus has
shifted from the provider to the patient .Patients want to take more control of their health and are open
to new ways of receiving care .They no longer want traditional models of healthcare that are usually
disparate and siloed .Another trend is the continuum of care beyond the hospital Specifically, home
health .With an inadequate number of beds, many healthcare providers are focusing more on how to
install digital technologies for remote patient monitoring, such as telemonitoring, IoT, connected
devices and wearables .This helps enhance patient convenience and reduces healthcare costs for the
Indian health care is astory of great contradictions :ithas one of the lowest cost health care systems in
the world, yet itis unaffordable to the large majority of its population .While we have institutions and
providers, both private and public, that are comparable to the world sbest in secondary, tertiary and
quaternary care, we have along way to go in providing basic primary care beyond the urban limit where
70 % of the population resides .While the Government of the day, during the last decade, has been
speaking the language of Right to Health and Universal Health Cover, yet the public expenditure on
health at around 1% of GDP isone of the lowest in the world .For 16 % of the world spopulation we have
adisproportionately high share of global disease burden at 20 % coupled with one of the fastest growing
noncommunicable disease incidence . At the same time, we have one of the weakest health
infrastructures at around 1.3beds per 1,000 people . 2
Healthcare in India iscomplex due to the multi -layered architecture of health system administration .
There are various considerations for this multi -layered hospital administration architecture .
These include whether itgets public (Central or state government) or private funding, what location it
covers (rural or urban) and what demography and prevalent diseases itcovers .
1.1Patient and Family Preparation
Develop materials and consistent messaging to increase awareness for patients and
families .For example, working as patient and family advisors .
Develop and implement standardized training programs that explain roles, outline
expectations, and prepare patients and families for partnering with healthcare
organizations, including helping them understand organizational structures,
unfamiliar terms, quality improvement processes, and how to effectively share
1.2Clinician and Leadership Preparation
Implement mechanisms for patients and families to partner with leaders of
medical, nursing, and other health professions schools on curriculum development
Develop a national curriculum to address patient and family engagement
Provide opportunities for experiential learning, observation, and hands -on practice
related to patient and family engagement .
Formally assess student spatient and family engagement competencies and skills .
At Home Even Before Entering The Hospital Within The Hospital
2.1Care and System Redesign
Employ communication techniques that support patients, including active listening,
asking questions to understand the patient perspective, and using teach -back methods to
Employ communication approaches, such as motivational interviewing, that encourage
patients to identify and work toward their own goals .
To Create advance directives and orders that are readily accessible, for example, in
Implement support programs to address clinicians emotional well -being .
Leverage technology to support and manage the flow of data across all healthcare
providers and systems, for example, acommunity -wide health information exchange with
Develop and implement training programs to help clinicians, staff, and healthcare leaders
understand ways in which patients and families can participate in organizational design
and governance, for example, working as patient and family advisors .
Establish patient and family advisory councils in hospitals, primary care settings, nursing
homes, and other healthcare organizations .
Include patients and families as members of organizational quality and safety
committees, including root cause analysis teams and quality improvement teams .
Partner with patients and families on hiring and staffing issues, for example, performance
3.1transparency and accountability
Structure electronic health record fields to enable patients to include information that
isimportant to them, for example, patient goals .
Provide unbiased, evidence -based information that can be easily accessed and used by
clinicians, patients, and families to support care planning and decision making .
Employ portals that allow patients to access their electronic health records anywhere .
Provide patients with personalized, estimated costs to use in decision making around
various treatment options and in care planning for managing chronic conditions .
Implement procedures for sharing organizational performance related to safety such
as never events, near misses, and medical errors with patients and families in ways
that promote transparency without creating apunitive environment for clinicians .
Make all healthcare cost, pricing, and charge data public .
3.2Measurement and Research
Develop measures that assess patient and family experiences and outcomes relative to
patient -specified goals, for example, ask patients about their treatment goals, record
these, and measure whether they are achieved .
Explore methods that collect more detailed and personalized data about patient
experiences and outcomes, such as using video to capture interactions and
Create patient experience maps charting staff and patient input to understand
expectations at various care points and identify areas for improvement .
Movement Across Hospital After Exiting The Hospital Along With
4.1After exiting the hospital
Require that all hospitals create and implement a community
benefit plan to improve the community environment and address
Require that hospitals hold at least one public meeting annually .
Develop opportunities for patient and family representatives to
be involved in decision making related to setting clinical quality
standards, reviewing research grants, and determining research
Prepare background information on important policy topics and
programs to help patients and families become familiar with key
Frequent communication with the patient and family members .
Customize plans so as to ensure patient actually follows the
The continuum of care is important to caregivers and patients alike, and it leads to an improvement of the satisfaction level , reduces costs and improves health. Keeping up the continuum of care is
especially significant for those patients who are more dependent on the health services, elderly patients, patients suffering from complex medical conditions, mentally vulnerable patients and
patients with chronic diseases. Some of the technologies that are relevant across the care continuum to create real -time standar ds based interactive digital information and collaboration
Ensuring privacy of patients through double verification,use of biometrics.
Ensuring privacy of patients through double verification, use of
Re -identification of users at quarterly basis .
Secure end to end, providing an environment of trust .
Optimization of cost and less double entry book keeping .
Ensuring improved cash flow due to faster transaction settlement .
Drug traceability in order to avoid illegal prescription .
Efficient management of patient data .
Upgradation of systems to quantum computing, enabling quicker and
Watson Cognitive computing excels by providing confidence levels for
Example :Watson provides evidence -based treatment options for
oncology patients based on outcomes and allows for personalizing
The world is rapidly becoming more digital, and any business not realising and
incorporating this trend will fall behind .India has the potential for digital growth,
given its current technology penetration, advancing economy, growing population and
accelerating healthcare industry .The rise of digital technology is pushing India to
achieve health for all, putting the country at the forefront for foreign investment .With
these opportunities, India isemerging as the global leader in digital health
What does itmean for healthcare in India
Better patient outcomes
Increase patient engagement
Enhance information flow
Patient centred care is central to the mission of healthcare, yet traditionally
neither patients nor the public have had the power to shape the services they
use and pay for, or define their value. In India, the issue for billions of people is
not whether care is patient centred but whether it is available at all, its poor
Its time to get real about delivering person centred care. It s not a panacea for
all of medicine ills, but we should not underestimate its contribution to
tackling them. Working collaboratively and sharing decisions about care,
services, and research is challenging. It requires a sea change in mindset
among health professionals and patients alike. But its rewards are rich and
Respect for patients values, preferences and expressed needs : Involve
patients in decision -making, recognizing they are individuals with their own
unique values and preferences .Treat patients with dignity, respect and
sensitivity to his/her cultural values and autonomy .
Coordination and integration of care : During focus groups, patients
expressed feeling vulnerable and powerless in the face of illness .Proper
coordination of care can alleviate those feelings .Patients identified three
areas in which care coordination can reduce feelings of vulnerability
1)information on clinical status, progress and prognosis .
2)information on processes of care .
3i)information to facilitate autonomy, self care and health promotion
Continuity and transition : Patients expressed concern about their ability to care for
themselves after discharge .Meeting patient needs in this area requires the following :
Understandable, detailed information regarding medications, physical limitations, etc .
Coordinate and plan ongoing treatment and services after discharge .
Emotional support and alleviation of fear and anxiety : Fear and anxiety associated with
illness can be as debilitating as the physical effects .Caregivers should pay particular
Anxiety over physical status, treatment and prognosis
Anxiety over impact of the illness on themselves and family
Anxiety over the financial impact of illness
Access to care : Patients need to know they can access care when it is needed .Focusing
mainly on ambulatory care, the following areas were of importance to the patient :
Access to the location of hospitals, clinics and physician offices
Availability of appointments when needed
Accessibility to specialists or specialty services when areferral ismade
Clear instructions provided on when and how to get referrals .