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ROCKLAND HOSPITALS: INNOVATING HEALTH CARE IN INDIA (B)

Professor Neena Sondhi wrote this case solely to provide material for class discussion. The author does not intend to illustrate either
effective or ineffective handling of a managerial situation. The author may have disguised certain names and other identifying
information to protect confidentiality.

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Copyright © 2015, Richard Ivey School of Business Foundation Version: 2015-07-08

January 2014 saw the operational launch of a 500-bed Rockland hospital in Manesar, Haryana. It was a
super-specialty hospital and part of the company-owned medical corridor. It brought the bed capacity of
the Rockland Group to 808 beds.

The first Rockland hospital had been set up in 2004 under the auspices of a trust, the Foundation for Applied
Research in Cancer (FARC). In 2007, this trust transferred all operations and management rights to
Rockland Hospitals Limited. The core philosophy of Rockland’s promoters had always been to create a
patient-centric model of high-quality health care service delivery with affordable costs. To accomplish this,
the Rockland Group had conducted a survey of 3,000 doctors across Delhi and neighbouring regions, which
identified a huge chasm between those in need of diagnosis and treatment and the number of available
service providers.

Rajesh Srivastava, chairman and managing director (CMD) of Rockland Hospitals, had been in the service
sector long enough to recognize that even though it was a dire situation, there was the possibility of a
solution. This optimistic and zealous entrepreneur was known for taking on challenges and converting them
into successful business models (see Exhibit 1). The solution, he felt, was to build a health care network
that could connect patients, clinics, diagnostic centres and medium-sized and specialty hospitals seamlessly
through an information technology interface.

Srivastava knew that the service model was a benchmark in itself. The real challenge was in its successful
implementation and management. The essential requirement of the model was a well-integrated, supportive
infrastructure. A service model that necessitated multiple stakeholders and partners required a firm
commitment and faith among all involved. Hence, when profitability and growth came with the necessary
preconditions of coordination, transparency and accountability, how could one ensure effective, efficient
medical treatment and services to the end user? Srivastava was confident that his team had the knowledge
and capabilities necessary to handle service quality and delivery at the tertiary end. The question was how
to ensure that there were no shortfalls or delivery failures — or, in the worst-case scenario, disasters — at
the primary and secondary levels.

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ROCKLAND HOSPITALS

The Rockland Group of hospitals had been created by the Srivastava brothers and was the brainchild of
Rajesh Srivastava, the oldest. The entrepreneurial group had variegated experience with multiple products,
including jeans, telecom and services/hospitality. It had homed in on health care after careful market study
and analysis.

In 2014, Rockland Hospitals was an INR3 billion corporate group that had been created as a family-owned
startup sourced with private funding by its promoters. The first hospital had been constructed and facilitated
by FARC, a trust set up by the same group of promoters. In 2008, the Rockland Group signed a share
agreement with the International Finance Corporation (IFC), a financial arm of the World Bank. In 2014,
12 per cent of the equity was held by IFC and the rest was held by the promoters. The IFC decided to invest
INR150 million into the venture in the form of shares. Alongside the IFC funding, promoters invested in
the land cost and INR8 billion into the successful rollout of the business model.1

The group had begun operations in 2004 with its first 100-bed super-specialty hospital. The initial plan was
to commission five individual hospitals as independent greenfield projects in the National Capital Region
(NCR) by 2020. Together, these five hospitals would provide 1,000 beds to serve the health care needs of
customers. Developing these projects was a labour- and cost-intensive job, and sustainability was a
challenge. The story would have been similar to that of any other corporate hospital group had it not been
for the comprehensive and unique five-layered medical corridor that the proprietors had envisioned (see
Exhibit 2).

Srivastava had not only been working steadfastly on setting up the hospital infrastructure, he was also
identifying opportunities judiciously in the county’s entire health care system. The clear service delivery
gaps and failures at the grassroots level and the high mortality rates, primarily due to a lack of access to
correct diagnostic and treatment facilities, identified the clear need for an integrated mechanism to deliver
health care to remote, underserved areas of the country. Although these gaps had been there for a number
of years, the advent of better technology, wireless connectivity and improvements in the country’s
infrastructure had led Srivastava to envision the Rockland network model and to realize that the time was
right to set up a more efficient and effective process. This was built into the Rockland vision and mission
(see Exhibit 3).

THE ROCKLAND HEALTH CARE DELIVERY NETWORK: OPERATIONAL MODEL

The entire model had been designed as an integrated health network that would connect four tertiary care
super-specialty hospitals, originally part of the Rockland medical corridor, by means of a chain of partners
and associates in a five-layered system.

To reach patient-consumers at the grassroots level, the Rockland corridor would be connected through
smaller hospitals, nursing homes, diagnostic laboratories, imaging centres, general practitioners (GPs) and
health workers. The group also recognized that another way to serve the health care needs of the vast,
sprawling country was to look at possible alliances with existing health care infrastructure and care
providers, a large majority of whom were in the government sector. Srivastava was well aware of the
public–private partnership model, which had considerable merit if one wanted to partner with a federal- or
state-level partner (see Exhibit 4).

1
Soma Das, “Rockland Plans Rs.1200 Crore, Five-Layered Healthcare Model,” Financial Express, July 20, 2012.

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The group also would work with technology and equipment partners to ensure smooth, efficient delivery.
The equipment partner would be responsible for identifying and procuring necessary medical equipment
and providing technical training for health care professionals who handled it. The technology partner would
be responsible for linking diagnostic equipment, labs and members of the health care network. It would
also provide software for imaging and for managing the pharmaceutical supply chain. Technology support
would be provided by Information and Communication Technology, which would ensure that the medical
history of every patient who had consulted a network partner was maintained in a central server. The patient
referral system would work up the chain from the health worker or GP to the nursing home, hospital or
super-specialty hospital where the patient was being treated. All details of patient inflows, medicine sales,
lab testing/imaging and hospitalizations would be maintained in the Rockland hub. “Health care is all about
trust, so transparency through e-recording of all transactions is very important so that all records can be
traced back in case of ongoing treatment by any other doctor and in case the payer wishes to audit the
hospital bills with the line of treatment prescribed by the treating doctor,” said Srivastava.2

Once a standalone clinic or GP became part of the network, diagnostic testing facilities, imaging, pharmacy
and IT support would all be put in place with the help of Rockland and the equipment and technology
partners. The commercial arm, including everything from billing to sales, was to be the Rockland Group’s
responsibility. Below is a brief description of the key players who would form the five-layered model.

THE ROCKLAND VALUE CHAIN: KEY PLAYERS

Tertiary care, the Rockland medical corridor: This corridor would include the five hospitals that were part
of the original business plan. All five were strategically located, spread across the entire NCR from east to
west. Another major advantage of these group hospitals was that they were in close proximity to the
Rockland Inn and Hotels (see Exhibit 5).

Currently, three of the Rockland hospital units, with a capacity of more than 800 beds, were fully
operational and functioning (see Exhibit 6). These hospitals were in close proximity to state highways and
national and international airports.

The two hospitals located in Delhi were less than an hour’s drive from each other, and in most instances
the same team of doctors, consultants and surgeons was able to see patients at both. The hospitals were
fully equipped to provide comprehensive service in terms of diagnostics, clinical care and pre- and post-
support services. The hospitals served as a hub connected with secondary and primary health care centres
to serve the health care needs of the huge, underserved population of the capital city.

The hospital at Manesar was equipped to serve as a centralized hub. Manesar had a locational advantage
and considerable infrastructure benefits. Three expressways were being constructed and would be
operational by 2014‒2015, reducing travel time from South Delhi, Delhi and Haryana to Manesar. Thus,
access to this large, super-specialty hospital would be accomplished in exactly half the time that it took to
reach Manesar from these areas. In addition, this was the only hospital in the group that had an ancillary
building with 65 serviced double rooms to ensure hospitality and lodging facilities for attendants and
relatives accompanying patients. A snapshot of the Rockland hospitals is available in Exhibit 7.

Secondary care: The secondary care hospital would need to have 30‒40 beds for patients, a fully equipped
operating theatre and all necessary emergency evacuation support, such as trauma care and ambulances.

2
“When Innovation Meets Care,” eHEALTH, http://ehealth.eletsonline.com/2013/03/when-innovation-meets-care, accessed
April 29, 2014.

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This segment would include both public and private nursing homes and small hospitals in the identified
states. These would operate on a revenue-sharing model (based on a franchise fee) or would be part of a
brownfield project, in which premises might be owned by a local person or doctor but would be equipped
and managed by Rockland employees. The partners would arrive at a mutually acceptable revenue-sharing
formula with the Rockland Group. In addition, the health care partner (the hospital, nursing home or GP)
would pay a monthly fee of a few thousand rupees for availing itself of four services of the model:

 Affiliation with the Rockland brand name.

 Using software services that were part of the five-layered network model.
 Serving the patients who worked for public- and private-sector organizations that were empanelled3
with Rockland Hospitals.
 Serving the patients who were insured by insurance companies empanelled with Rockland Hospitals.4

Primary care: This layer would include smaller clinics, usually owned and run by GPs and located in small
towns, sometimes villages. The local GP might reside in the area for family or personal reasons. He or she
would possess a basic medical degree and in most cases would be a general physician. The clinic or
premises where the doctor practiced most often would be either a resident clinic or a self-owned/rented
clinic. It might be equipped with very basic medical equipment and might not have any diagnostic or
surgical facilities. There might be a compounder and/or nurse, who in most cases would have been trained
on the job in health delivery.

If the doctor decided to be part of the Rockland network, he or she would be able to display the affiliation.
This doctor would be required to pay a franchise fee to Rockland for the membership and would be able to
refer patients to a secondary or tertiary partner if needed. He or she also could use Rockland’s diagnostic
facilities as needed. Since the doctor would be part of the Rockland network, his or her patients would be
assured accurate diagnosis and timely treatment.

Diagnostic centres: The diagnostic centres would be established at strategic locations in the state where the
network was rolled out. The idea was to ensure that the centre would serve the health care and diagnostic
needs of those residing in the area. The precondition for empanelment in the network was that the diagnostic
centre would have a fully equipped and functional pathology lab, with the latest equipment, imaging
facilities and technologies. The empanelled lab would then be connected to the central management
information systems at Rockland Hospitals, and all Rockland patient records and data would be centrally
managed and maintained. This data would be studied periodically to identify seasonal, regional and general
trends.

It was proposed that each centre would serve patients within a radius of 50 kilometres. The centres would
be a mix of promoter-owned and vendor-owned diagnostic and imaging labs. In the case of vendor-owned
labs, the group would enter into a revenue-sharing agreement, depending on the number of referrals from
Rockland affiliates and Rockland-enrolled patients carrying a Rockland identification number, who came
to the lab for diagnosis.

Private health workers: The private health worker would be the first contact point for the patient or patient’s
family. This person could be a government accredited social health activist (ASHA)5 worker or a self-
3
Empanelled means that employees of the organization can use the services of the hospital at a lower/subsidized cost.
4
In 2014, 56 insurance firms and third-party administrators, as well as 130 corporate houses, were on the Rockland panel.
5
ASHAs, or accredited social health activists, were female community health workers trained under the National Rural Health
Mission. They were responsible for building awareness and education for health and sanitation practices. They were also
trained to provide basic first-aid and treatment as well as maintain health and demographic records. Currently, there were
500,000 ASHA workers in the country.

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employed individual. The health worker would most likely be from the local community and would have
the will and temperament to reach out to people of all communities and groups. He or she would be trained
to identify common ailments as well as symptoms of diseases prevalent in the area. Rajiv Tewari, director
of strategic communications of Rockland Hospitals, observed, “You can think of him as your newspaper
hawker, who is a self-employed, independent operator. He delivers your daily dose of news 365 days a
year, and without him the entire media industry would collapse. Thus, it is my firm belief that for any mass-
scale initiative to be successful there has to be harmony between the unorganized and the organized sector.
It is people like the newspaper hawker and TV news stringer6 who have revolutionized the media industry,
and I think replicating the model in the health care industry is the key to delivering accurate and timely
health care in this vast country.”

The health worker who decided to partner with the Rockland Group would be provided contact information
for all other health worker partners and the service details of all empanelled members of the Rockland
network, such as the primary care clinics, diagnostic and imaging centres, and secondary and tertiary care
hospitals. Then, based on the seriousness and stage of the problem, he or she would refer the patient to the
appropriate treatment or diagnostic centre. The health worker would be given basic training in identifying
the ailments most common in the area. He or she would be provided a smart device, such as a phone or
tablet, on which this information would be readily available. The worker would be provided updates and
modular training in the event of new technologies or new diseases/calamities in the area. The worker would
have information about the organizations and insurance providers empanelled with Rockland, and would
be able to guide patients and their family members on procedures for getting support.

THE ROCKLAND NETWORK: CURRENT STATUS

The network model had started with the three tertiary hospitals that Rockland owned and managed in the
NCR. With investment of an additional INR4.75 billion, the fifth and last tertiary hospital, a 500-bed, multi-
specialty hospital at Greater Noida, was to be operational by the end of 2015.

Srivastava had proposed to cover in the network at least 200 districts in neighbouring states in north India
by the end of 2020. He was looking at multiple partners and growth engines to achieve his dream project
— the comprehensive health care model he had planned meticulously with his brothers and his team of
medical and business experts. He knew that the model was the answer to India’s health care needs. And if
it worked, he had a vision to replicate the model in other parts of the country and to look at doing so in
other developing countries, such as those in Africa and the South Asian Association for Regional
Cooperation nations. The model had direct social benefits and also extremely profitable; however, it came
with unique challenges.

Rockland Hospitals promised high-quality health care; in fact, Rockland doctors had performed unique,
trail-blazing surgeries. Would the same health care be delivered when there were multiple partners
involved? Multiple stakeholders meant diverse motives and operating models. How did one ensure smooth
coordination at all levels? Should the Rockland partners be from the government or the private sector?
Would it be better to have affiliates partners or Rockland Brownfield projects? And adding to the woes was
the fact that the primary health workers, who were the first interface with patients in remote locations, were
largely self-employed. As that sector was totally disorganized, how did one ensure accountability to the
affiliation that the Rockland model mandated? India was a country in the midst of change, and in

6
Stringer: This person was usually self-employed and worked as a sort of freelance journalist or news reporter. He or she was
alert and responsive to any unusual news or event that might have the potential for a regional or national television channel.

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Srivastava’s heart he knew that the five-layered network model could be a harbinger of improvement in
Indian health care.

As Srivastava gathered his papers together and prepared to address the Rockland board of directors, he
wondered what the rollout plan for the model should be. Should they start at the macro level and begin with
the secondary hospitals? If so, should Haryana be the pilot state, with the unit in Manesar as the centralized
hub, or would it be better to look for partners in the NCR, with the older, better-recognized and established
Delhi-based units in the Qutab Institutional Area and Dwarka? The network of government ASHA workers
was equally well established, so should they begin by first empanelling at the grassroots level and then
move up to primary and secondary clinics? So many possibilities existed for closing the gap between
demand and supply and serving the health care needs of those residing in the remotest corners of this huge
country. The project was special, and Srivastava wanted the execution to live up to his ideals.

The author would like to acknowledge the help received from Mr. Rajesh Srivastava, CMD, Rockland Hospitals,
and Mr. Rajiv Tewari, director of health & wellness, Rockland Hospitals, in the preparation of the case.

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EXHIBIT 1: RAJESH SRIVASTAVA — THE ROCK BEHIND ROCKLAND

Transcript of the author’s interview with Mr. Rajesh Srivastava, CMD, Rockland Hospitals, on September 30, 2014, at
Rockland Hospital, Qutab Institutional Area, New Delhi.

Author: What is that magic ingredient that makes an entrepreneur? What was special about Rajesh Srivastava?

Rajesh Srivastava: First thing is that your approach to whatever you do should be simple. You always have to be in
learning mode, seeking information and looking for solutions that are grounded and not fancy. See, you may say, start
with a higher vision, a business model, a strategic perspective. But I say, no, start with looking inward. What are my
capabilities and what are my resources? There are outside resources, also. But the ability to plan and use your and
outside resources to deliver optimal value to the customers has to be done by you. Another thing that I have always
done is never to think that I know more than my customers. Because the day I do that, I will become arrogant, and what
I will create will be my addiction and not a product or a possible business offering. So, putting yourself into the shoes
of the customer is most important. Now, you look at health care. Poor or rich, all want the right treatment. So the first
thing is he wants to know, “What is wrong with me? It is my body, so I have a right to know. What are the treatment
options for me? Where can I go for treatment? Should I go to primary care or secondary care? How much will the cost
be to me? Are there different options from which I can chose? Can I trust this doctor or hospital to give me the right
advice?” You need to understand, he is not coming to have a picnic at your hospital; he needs your full and transparent
support. If you can give it, the customer is yours forever.

Author: At a young age, you started your business with your brothers, and today you have the second generation of
Srivastavas joining the business. What are the challenges of a family-run business?

Rajesh Srivastava: I have been lucky, because as a team, my family and I were able to experiment with multiple
projects. My belief is that if the family who started the enterprise starts thinking of themselves as owners, then they will
ruin the business. They are stakeholders, promoters and should support and manage what is created. Second, based
on their individual talent, they should take care of seeing that the business is being run the way they envisioned it and,
further, work toward growing the business. And once a family member, young or old, takes the responsibility, then you
have to give full control to the person. Let them decide and execute and not try to control them. I consider my team,
whether family members who are part of the management team as well as the employees who work in the organizations,
as the “energy.” It is their passion and goals and targets which grow the company. And, since all members are
stakeholders, they are all committed to seeing that the business flourishes and does not collapse; they will not let it
collapse. When I give them a free hand, I also hand over the responsibility of handling blunders or failures that may
happen. Any decision will have both sides, but how it is to be sorted and solved has to be thought of by them. Of course,
the team is there to support, but the onus of what needs to be done has to be there. That is the only way to learn.

Author: You spoke about learning, so what would be the right background and knowledge that would make a successful
entrepreneur?

Rajesh Srivastava: There are no schools and no courses. Anybody, even a young child of 17‒18, a school dropout,
could have an idea. This could be generated because of a passion, interest or simple necessity. Whatever the case
may be, the person must distinguish between “idea” and “ideal.” The world is not perfect, and so one must be practical,
look at one’s capabilities, resources and, next, start seeking market or technical knowledge, information. This has to
be from the user’s point of view. Passion may be yours to do something, but the winning idea will be the one that is
thought by putting yourself in the consumer’s shoes. And if you do that, believe me, you will never become common,
but will always stay connected with your customers and stakeholders.

Author: You have successfully led multiple business ventures, from books to hospitality to health care today. What
was the imperative to look at such diverse propositions?

Rajesh Srivastava: Business is like opportunities and circumstances that you face in everyday life. You have to have
a reason, you need some resources and there needs to be a transaction possibility. I was lucky that from a very young
age, I got an opportunity to carry out monetary transactions. My first opportunity came from my mother, when she asked
me to go and buy vegetables. So, my first learning began from there, where I went to the wholesale vegetable mandi
(market) and learnt my first lesson of seeking the best quality at the best price and negotiating for maximum gain. I
would give logical and sound arguments about why the vegetable seller should give the vegetable at a certain price to
me. This helped me later when I was in school and I was told to get the supplies, food and vegetables for our National
Cadet Corps meeting. So I went to the same market and got the raw material at a cheaper rate and my teachers praised
me a lot for my effort and savings for the school. I did not get any money for my work but got a lot of praise and

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EXHIBIT 1 (CONTINUED)

recognition, the best uniform, an opportunity to play football and so much respect from everyone, and this made me
happy. So, [there are] two principles that have been the foundation of all my ventures. One, look for the best quality
and don’t compromise on what you give to the customer; for this, you must thoroughly explore all possible options
through which you can give this quality to your customer. Second, go and negotiate for the best price and share the
cost advantage with your customer. It is again a relationship that you form; if you take care of the customer and he
recognizes it, he will, in return, not leave you and stay loyal. My principles were very simple: I always tried to look at
people around me, you can call them customers, and see what is it that they seemed to want or need, where they were
facing a problem or some kind of gap. Next, I looked at my own capability and resources. See, there are hundreds and
thousands of opportunities in the market. The question is, “What is it that gives you the capability or resources to be
able to get into that field?” When I got into business, my thoughts, whether it was a simple school initiative or today
when I am in health care, were the same. I saw an opportunity, I felt I could do it and I just acted on it. For me, the
action was more important and not whether I was successful. I felt that I was able to match the needs of the market
with my resources and deliver a good product at a good price to my customer. That act was my measurement of my
success.

Author: Were there any aspects of health care that were different from your earlier businesses?

Rajesh Srivastava: Definitely, as I told you, any business starts when you understand that there is a customer and,
next, you understand what he wants. In the case of health care, there is no single customer. The need for treatment
and health is for everyone, no matter what is his background, class, age or religion. And what is the most important
thing that the customer wants with treatment? He wants to know what ails him. So, he wants correct diagnosis. Next,
he wants to know, “How much will the treatment cost? What are the medicines available in the market and at what
price?” He wants trust that he is getting the right treatment for the specific problem and so he looks for a brand that he
can trust.

Author: What is unique about your current business and what are the steps that you have taken to take care of your
customer here?

Rajesh Srivastava: Health care is very interesting, as there are multiple people here who have different needs. The
patient wants to know how he can get the best care at the best price. He also wants to know what his medical condition
is and is the treatment he is getting correct. So, diagnostic centres are important. A centralized mechanism for keeping
the patient records is important.

We realized that there were doctors in villages, but they did not have diagnostic facilities. The customer was not sure
he would be treated properly, so he was rushing to city hospitals, in some cases super-specialty hospitals. So, the
tertiary hospitals had a large number of patients who could be treated in primary or secondary care and need not travel
so much. Again, the point is saving on customer cost. The situation is complex, as my patient is also my customer, and
so is the insurance company, who wants that the patient should be treated at minimal cost. So, right knowledge about
the problem and the place at which the disease can be effectively treated becomes the focal point. So, we looked for
people who thought like us and believed in the health care model we had developed. This included diagnostic partners,
technology partners and doctors and health care units, primary and secondary. All the stakeholders stood to gain,
provided all of them worked together.

Author: As partner selection is a very important aspect of model efficiency, who is a better partner — a private player,
government player or international player?

Rajesh Srivastava: Currently, this is a pilot project, so we have all kinds of partners. Selection criteria are that they
believe in the viability of the model, cost and quality are both regarded as important to customer value, and they are
able to see how this will increase their volume and, therefore, profitability. Once the project is working fine, we will be
in a better position to assess which of the partners is better.

Source: Author’s interview with Mr. Rajesh Srivastava, CMD, Rockland Hospitals, September 30, 2014, at Rockland Hospital,
Qutab Institutional Area, New Delhi.

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EXHIBIT 2: THE FIVE-LAYERED ROCKLAND HEALTH DELIVERY MODEL

Source: Company documents.

EXHIBIT 3: ROCKLAND HOSPITALS — VISION AND MISSION STATEMENT

Vision: To be the most trusted health care brand nationally and internationally.
Mission: To create a network of quality health care service providers up to village levels at affordable costs.
Goals: 2020
 Creation of a Rockland Medical Corridor with a network of tertiary care hospitals in the Delhi NCR.
 Creation of a five-layered health network to connect the Rockland tertiary care hospitals with small hospitals,
nursing homes, clinics & health volunteers to reach out to patients in remote locations.
Values: When people feel for others, when people who are determined get together, things happen.

Source: Company documents.

EXHIBIT 4: PUBLIC–PRIVATE PARTNERSHIPS (PPP) OVERVIEW

Health surveys done by the World Health Organization, UNICEF and CRISIL clearly indicate the huge gap in terms of
both resources and infrastructure necessary to meet the health care needs of the country. Policymakers are well aware
of this fact and are taking a number of positive measures to meet these shortfalls. PPP is a tried and trusted model
across geographies and sectors. Essentially, it entails that government institutions partner with private parties to deliver
services to customers. PPP in the health sector has been implemented successfully in both developing and developed
nations. In the model, two parties can together ensure equitable (public) and efficient (private) service delivery
mechanisms. While economies of scale are the strength of the public sector, the latest in terms of technology and
operations is the guaranteed contribution of the private sector. Models that are available in the health care sector can
be put forth on a continuum from fully public (government owned, funded and managed) to fully private
(individual/trust/corporate owned, funded and managed). PPP models include:

 Contractual: A public arm owns the infrastructure. A private firm is hired for a specified period to manage all or part
of the service operations for a mutually agreed-upon fee. The period is specified both in terms of duration as well
as service-quality indicators.
 Leasing: Public infrastructure is leased to a private player for a specific period with a clear buy-back agreement
with the government, by way of a percentage of bed occupancy or profits or through allocating subsidies during
the period.
 Joint ventures: Legal agreement between two partners with terms of equity participation and profit sharing mutually
agreed upon.
 Concessions: This could be for totally new as well as existing health care units. The private sector could manage
and operate all aspects of a new project for a fixed/long-term time period. Alternately, there could be a similar
agreement for an existing unit. The important issue is that all operational and expansion risks are to be decided on
and borne by the private player. The public partner is more a silent partner and usually takes an agreed-upon
percentage of the unit’s service profits.
Source: “PPP in India’s health sector,” KPMG, www.kpmg.com/in/en/issuesandinsights/articlespublications/investing-in-
india/pages/gov-july2012.aspx, accessed May 1, 2014.

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EXHIBIT 5: ROCKLAND MEDICAL CORRIDOR — NCR

Source: Company documents.

EXHIBIT 6: ROCKLAND TERTIARY CARE HOSPITALS — 808-BED CAPACITY

Source: Rockland website, www.rocklandhospitals.com, accessed July 19, 2014.

This document is authorized for use only in Shivani Gupta's Strategic Management in Healthcare 11.18.2021 at Goa Institute of Management from Nov 2021 to May 2022.
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EXHIBIT 7: ROCKLAND HOSPITALS — A SNAPSHOT

Information Qutab Dwarka Manesar

head
1. Timeline Commisioned in 2004; Commisioned in 2012 Commisioned in 2013
doubled capacity in 2013
2. Capacity 6 operation theratres; 52 2 operation theatres; 22 8 operation theatres; 150
ICU beds; 148 beds ICU beds; 80 beds ICU beds; 345 beds
3. Bed occupancy 68 60 42
(%)*
4. ALOS** (days) 2.9 3.3 3.8
5. Revenue by 28 – orthopedics 46 - orthopedics 38 - orthopedics
services (%) 23 - cardiology 11 - cardiology 15 - cardiology
19 - outpatient 18 - OPD 19 - OPD
department (OPD) 18 - paediatrics; 21 - paediatrics;
15 – paediatrics; gastroentrology; general gastroentrology; general
gastroentrology; general surgery; gynaecology surgery
surgery 7 - diagnostic; 7 - diagnostic;
15 - diagnostic; opthamology; oncology; opthamology; oncology;
opthamology; oncology; opthamology; dental; opthamology; dental; ear,
opthamology; dental; ear, nose and throat; nose and throat; others
ear, nose and throat; others
others
6. Staff Permanent doctors – 81 Permanent doctors - 34 Permanent doctors - 55
Visiting doctors - 44 Visiting doctors - 83 Visiting doctors - 1
Outsourced - 162 Outsourced - 83 Outsourced - 110
Nursing staff - 156 Nursing staff - 77 Nursing staff - 130
Paramedical - 64 Paramedical - 29 Paramedical - 37
Support -168 Support - 77 Support - 97

7. ARPOB*** (INR) 21,523 19,068 32,988

8. Revenue (INR) 1 billion (FY2014 1st 450 million (FY2014 1st 450 million (FY2014 1st
quarter) quarter) quarter)
9. EBITDA**** 294 million (FY2014 1st 109 million (FY2014 1st 109 million (FY2014 1st
(INR) quarter) quarter) quarter)
10. Distance International Airport - 12 International Airport - 12 International Airport - 35
km km km
Central Delhi - 15 km Central Delhi - 20 km Central Delhi - 50 km

*Bed occupancy: Industry standard is 75–80 per cent.

**ALOS: Average length of stay (industry standard is 3.3 days).
***ARPOB: Average revenue per operating bed.
****EBITDA: Earnings before interest, taxes, depreciation and amortization.
Source: Company documents.

This document is authorized for use only in Shivani Gupta's Strategic Management in Healthcare 11.18.2021 at Goa Institute of Management from Nov 2021 to May 2022.