Tagged: paediatric heart surgery

Devi Shetty’s hospital of the future
London heart attack sufferers taken to a specialist cardiac centre have a 60% chance of survival, whereas those taken to a standard A&E unit only have, at best, a 26% chance of survival: according to unpublished information from the London Ambulance Service.

Experts say that the current provision of cardiac services in north and east London have, "relatively poor patient outcomes in comparison to the rest of England", and suggest that St Bartholomew's Hospital in central London should be transformed into a huge cardiovascular surgery unit, and a hub for a comprehensive network of care, which would embrace GPs and local hospitals.

For years, Devi Shetty, world-renowned heart surgeon, philanthropist, Founder, Chairman and Executive Director of Narayana Health, one of Indian’s leading private hospital groups, has argued that, "One hundred or 200 bed hospitals are not the solution". Narayana Health has Asia's largest cardiac centre providing affordable world-class cardiac care. "Large specialist cardiac centres, treating high volumes of patients, staffed by specialists and equipped with the latest technology, save lives, reduce complications, lower costs, and are the hospitals of the future," says Shetty.

The Bart's heart centre
The proposed new Bart's Heart Centre is similar in concept to Shetty's 1,000-bed cardiac hospital in Bengaluru, which attracts patients from more than 70 countries, and each year, performs some 7,000 surgeries; 50% on children and new-borns. It also serves as a centre of excellence for cardiac services in regional communities.
The importance of culture
Besides size, Shetty also appreciates the significance of culture in developing the hospital of the future.
In Narayana's 24 hospitals in 23 cities, Shetty has developed a culture of improving clinical outcomes while reducing costs. All Narayana's 14,000 employees are committed to providing affordable world-class integrated healthcare services for people with complex medical needs.
No matter how large the new London cardiac centre, without an outcomes-orientated culture supported by every employee, the quality of patient care is likely to be inferior to that of Narayana Health.
Outcomes obsessed
Narayana's outcomes data are systematically collected, organised, widely shared and used to improve clinical guidelines and decision aids. Data sharing in Narayana creates peer completion and self-regulation, which improves clinical outcomes, without incurring the costs of heavy regulation and unwieldy bureaucracy.
Narayana's surgical outcomes compare well against the world's best. Its mortality rate within 30 days of the high-volume coronary artery bypass surgery is 1.4%, compared with an average of 1.8% for England and 1.9% for the US. Were these figures adjusted for risk, Narayana's outcomes would be even better. Narayana's hospital-acquired infection rate is 2.8% per 1,000 ICU days, which is comparable with the best hospitals in the world.

Challenging professional assumptions 
Like their UK NHS counterparts, Narayana's senior surgeons provide consultations for patients, lead operations, train surgeons and discharge patients. Unlike their UK counterparts, they're incentivised to spend more time in the operating room concentrating on what they do best - complex surgeries – while junior surgeons open and close surgical procedures and other health professionals attend patients in ICUs.
Typically, Narayana's surgeons work 60 to 70 hours a week, perform up to five operations a day and a third of their compensation is profit related. By contrast, UK's NHS consultant surgeons undertake between three to four procedures a week and their pay is based on 10 4-hour programmed activities a week and anything more is paid overtime. Unlike the NHS, Narayana has no rifts between clinicians and administrators; both are responsible for financial management. Every day, every doctor and every administrator receives a text message with the previous day's profit and loss statement.

Narayana's heart centre in Bangalore is a MECCA for western policy makers. All come away inspired but suggest that Narayana is an “Indian phenomenon”.

Perceiving Narayana Health as “Indian” fails to see the elephant in the room. In February 2014, Shetty opened a 140-bed hospital in the Cayman Islands as the first phase of a 2,000-bed Narayana Health City designed to capture share from the American healthcare market. "Our intention is not just to build a super specialty hospital; our intention is to build a hospital of the future," says Shetty.
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