Nagar Panchayat Hospital

Group 10:
Jis Tom Sunny
Rizwana Gouse
Steeve Irimpan
V. S. Seeja
Vinod C.
Panchayat
Situated in Vallabh Vidyanagar, Gujarat.
Elections were held once in every five years.
Elected members were responsible for the civic
amenities of the township.
Sub-committees of five members to oversee the day-
to-day operations.
Major source of revenue were from octroi (60%)
Major source of income from return on investment,
penalties, donations and borrowings.
Hospital
Part of local civic administration.
Health committee was set up for solving minor policy
issues.
CMO was in charge of the day-to-day operations.
Objectives of the hospital
 To provide domiciliary medical support to the residents
of the township.
 To undertake immunization services under the maternal
and child health programme.
 To undertake preventive programmes for checking
outbursts of epidemics.
 Cont…
Sources of revenue were through fees and donations.

Hospital had a total staff of 9 members and was done

centrally.

The challenge was to make it a self-sustaining unit.

CMO floated a project for the students of a leading

business school.
Suggestive measures
 Pharmacy division- no proper inventory management
model
 Maternity unit- ensure that the occupancy rate of the
maternity ward is high
 Equipment purchase-investment for equipment should be
sought as a grant either from the Panchayat or from the
state government or from a private donor.

Implemented these recommendations in right earnest.

Growth of the hospital
Occupancy rate had gone up.
Hired gynaecologist to visit hospital alternatively.
Labour room and the operating room for tubectomy were
renovated.
Investment for an ENT specialist, Sonography unit and ECG unit
Upgraded opthalmology division and public awareness
campaigns for population control, family welfare and polio
prevention.
Revenue from laboratory fees had more than tripled and the
revenue from the sales of medicine had quadrupled, from around
Rs.2.90 lakhs in 1993-94 to Rs.11.57 lakhs in 1998-99.
 Dispensary Revenue
1600000

1400000

1200000

1000000

Dispensary Revenue
800000

600000

400000

200000

0
1987-88 1988-89 1989-90 1990-91 1991-92 1992-93 1993-94 1994-95 1995-96 1996-97 1997-98 1998-99
Areas of Concern
Panchayat not ploughing the surplus back into
healthcare.
Cash donations to hospital going to general pool of
panchayat
Major decisions are centralized . Eg: Staffing
Operations now scaled up : Informal measures of
CMO will not provide the required results
What if the CMO leaves ?? Indicative of lack of
proper system.
Impressive Growth yet ….fragile foundation system
The Key Questions
Existing System Vs Autonomy
Profits Vs Service
Sustainability of the system
One man show Vs Team Performance
Putting all eggs in one basket?????
 ANALYSIS

1. 7-S Framework
2. Porters Five Force Framework
 7-S Framework
STRATEGY

 Low Cost
Low cost generic medicines
Providing facilities at 50 % of market price
STRUCTURE

Panchayat Members

Health Committee ( 5 members )

Chief Medical Officer

Staff members ( 8 members)

SYSTEM
 Inventory Management System

 Financial System
Deposition of receipts and Release of cheques for
expenses with the Panchayat daily.
Surplus generated going to general pool for cross
subsidization
Cash donations going to Panchayat
STAFFING
 Understaffed
 Centralized
 Informal measures of staffing
 Requirement of staff to be more capable to meet the
increasing hospital demands.

The number of patient registrations has increased from

12000 in 1993 to 25000 per annum
SKILLS
Medical Skills, Administrative Skills

STYLE
Autocratic leadership style of the CMO
Non-interference of the Panchayat in hospital
administration

SHARED VALUES
Providing quality healthcare at an affordable cost.
Porters five force model
Threat of new entrants in the market

 Moderate
not low : what if a hospital emphasizing charity comes
not high : capital intensive.

Bargaining power of buyers

 Low income people: low

 High income people: high
Bargaining power of suppliers
 Low cost medicine : low
 Branded medicine : high

Threat of substitute
 Moderate

Rivalry among existing firms

 Low
ACTION PLAN
Initiative to be taken by the Panchayat to create a
shareholding pattern for the Hospital.
Elections conducted among shareholders to elect the board
members.
CMO on the board as a representative of medical staff.
Final decisions on policies and administrative matters to
be taken by this board.
Recruitment of a Secretary to handle daily administrative
duties
Recruitment of Doctors and Support staff by a panel of
medical practitioners.
Recruitment : One year contract followed by
permanent posting

Surplus Allocation
10% to Panchayat
30% for infrastructure development in the hospital
30% for growth (diversification)
20% reach out (awareness) programme
10% for employee welfare
For Revenue generation : Attract patients towards
primary services.
Charges are as follows :
General Consultation : Rs.4
Special Consultation : Rs.10
(Validity of the registration is for 3 weeks only)

Increase in Awareness Programmes and Medical

Campaigns
 vs

Revamped System
Existing System Team of doctors
Autocratic leadership Better Succession Plan
Workload reduced, Better
High Workload
Salary
No team to support Better Empowerment
him Better Delegation
Need for Better Administration
Thank you