Article Detail
Article
Date: April 09, 2014
Title: Why the future of
health care can be found in the Cayman Islands
Source: KevinMD.com
The Cayman Islands
are nestled in the Caribbean Sea some 430 miles south of Miami. The
three-island cluster is known for its inviting coral-sand beaches, laid-back
island culture and tax-free status.
While it lures many
tourists and big banks, it’s not the first place you’d expect to find the
future of American health care. That may change soon.
Last month, I flew to the Caymans to moderate an
afternoon-long panel on delivering high quality, affordable health care.
Earlier in the day, more than 2,000 attendees from around the world gathered
under a large tent to celebrate the opening of a new 104-bed hospital.
Why all the fuss?
Because this new facility is the work of Narayana Health chairman and India’s
most renowned heart surgeon, Dr. Devi Shetty.
It has American
health care providers watching closely and anxiously.
Narayana
Health positioned to deliver quality care to Americans
At the end of 2013,
Narayana Health was operating 18 hospitals across 14 cities in India. With a
laser focus on efficiency and quality, the average Narayana cardiac hospital
performs 40 heart surgeries a day for less than$1,600 a case.
With the first phase
of the Cayman Island hospital completed in February, Dr. Shetty plans to expand
Health City Cayman Islands to 2,000 beds over the next decade. And both his
vision and strategy extend well beyond this Caribbean destination.
In the United States,
there is about 1 hospital bed per 333 people. The Grand
Cayman Island has about 50,000 residents. When Dr. Shetty completes his
expansion plans, his newest hospital will feature 1 bed per 25 Grand Cayman
residents. It doesn’t take a heart surgeon to see Dr. Shetty is thinking way
beyond the Caymans.
Given the hospital’s
close proximity to Miami, Dr. Shetty must be planning to attract patients from
the United States. That would certainly explain the 5-star hotel he built next
door with a foot bridge connecting the two world-class structures.
Today, Health City
Cayman Islands focuses on cardiac and total joint surgery. It will add cancer
care and transplant services in the near future. Plans are already underway to
construct an international medical school and a variety of high-quality
residency training programs. He expects this facility to become a global
academic medical center and a destination for the best medical school graduates.
Some American health
systems may scoff at the idea that Americans will travel to Health City. But if
Dr. Shetty can match the performance of his hospitals in India, his vision is
likely to be a reality sooner than they imagine. Already, the Cayman Island’s
business-friendly government has allowed Dr. Shetty to move ahead with
development much more rapidly than he ever could in the U.S.
Dr. Shetty’s
strategy: Charge less, treat more
In this new Cayman
Islands facility, Dr. Shetty will charge less than half the average U.S. price
for surgical procedures with quality outcomes that are likely to match or
exceed the very best U.S. hospitals.
His approach to cost
cutting is not based on paying lower wages. The Cayman Islands enjoy a similar
standard of living and wage structure as the U.S. And he won’t be purchasing
inferior supplies or medical implants. Nor will he use shabby construction or
outdated technologies.
In fact, his approach
is just the opposite.
Dr. Shetty buys only
the best heart valves and orthopedic implants. He invests heavily in
state-of-the-art medical and information technologies. And his construction
team tested the new hospital’s windows for hurricane conditions by battering
them with two-by-fours, launched at over 100 miles per hour.
How then could he
possibly reach this level of cost and quality? His approach builds on his
personal passion for quality, a fervor for operational excellence and a
commitment to technology.
The power of
purpose and vision
As Dr. Shetty
addressed the audience of 2,000+ during the dedication ceremony, his passion
radiated.
“One hundred years
after the first heart procedure was performed, only 10 percent of the world can
afford to have one,” he said. “We can and must do better. The future cannot be
just an extension of the past. It must embrace new technology, implement innovative
approaches and aim higher than people thought possible before.”
For those who doubted
it can be done outside the U.S., Dr. Shetty pointed out that “the greatest
leaps forward happen when a nation goes from nothing to the modern age.”
As an example, he
pointed to India’s recent communications boom. In less than a decade, the
nation went from limited telephone access to 850 million mobile phones. Without
an existing landline infrastructure, India could bypass the time and cost of
installing fixed phones in every home.
The same is true for
hospitals. A facility that offers very few advanced procedures today can
quickly leapfrog world-leading hospitals because – instead of slowly replacing
old technologies – they can immediately implement sophisticated, modern
technologies and cherry-pick the most innovative operational designs.
“[Health care]
affordability will not come from the United States or any of the current world
leaders, but rather from those nations of the world that have little today and
have no choice but to perform at the highest levels possible in the future,” he
said.
Dr. Shetty
understands that institutions must be economically viable. But he is also a
mission-driven leader. On that warm day in February, he concluded his remarks
by reminding attendees, “The day we turn anyone away from this place of healing
for an inability to pay is the day we have failed as an institution and
betrayed God’s commandment.”
How Dr.
Shetty achieves high quality at lower costs
So, what’s his
secret? Dr. Shetty and Narayana Health incorporate a four-part blend of
sophisticated technology and economies of scale to deliver exceptional quality
while managing costs:
1. Utilizing
real-time data
Patient care at
Health City Cayman Islands is supported by state-of-the-art technology that
uses a robust electronic medical record (EMR) system to augment clinical
care.
Every patient
admitted to the hospital receives a low-cost mobile tablet that’s manufactured
in India. The device contains each patient’s medical information collected
throughout his or her stay.
Doctors and nurses
access the encrypted information through Google Glass devices and
Bluetooth-enabled watches as they make their rounds. These devices allow
patients to communicate with doctors and nurses from anywhere in the hospital
while also staying connected with their loved ones far away.
When the patient
leaves the hospital premises, all medical information is immediately erased
from the tablet and stored on hospital servers.
A central care area
with four large wall-mounted computer screens allows physicians to continually
monitor patients. Three of the screens offer video monitoring of individual
patients along with their comprehensive medical data. The fourth screen shows
real-time performance metrics across the medical center, paying particular
attention to medical care delays.
2.
Eliminating medical care delays
According to Dr.
Shetty, time is the enemy of quality and cost savings.
“When patients have
potentially life-threatening problems such as a low blood-oxygen level,
diminished blood pressure or an untreated infection, their health deteriorates
with every passing minute,” he said.
Doctors can minimize
this deterioration by responding rapidly when unexpected clinical findings
surface. This allows the patient to recover much faster and reduces the total
cost of care.
You might think every
hospital would do this, but that isn’t the case.
To heighten the
hospital’s focus on rapid response, the EMR system Dr. Shetty built contains a
list of lab results and clinical findings that predict potentially significant
medical problems. Whenever a patient’s lab tests fall out of an acceptable
range or a nurse records an abnormal finding, the computer system launches an
internal clock, which records the speed of response. Once treatment begins, the
system documents the time it takes for physicians and nurses to respond
appropriately.
The hospital-wide
average time for an appropriate response in one of Dr. Shetty’s hospitals is
seven minutes. He hopes to cut that time in half. In the typical U.S. hospital,
this time delay is not measured. A best guess would yield 30 minutes during the
day and as long as an hour at night.
As Dr. Shetty
explained, “These delays mean prolonged hospital stays, increased medical
complications and even death.”
3. Leveraging
global time zones
Dr. Shetty recognizes
that time of day can predict the quality of care in a hospital.
“Hospitals are most
dangerous after midnight, since that is when the least experienced nurses work
and there are the fewest number of physicians available,” he said.
His goal: To provide
excellent care around the clock.
To accomplish that,
he staffs the central-care monitoring area with experienced physicians who
closely monitor patients – not just those in the Cayman Islands, but patients
and medical information half way around the world.
When it’s daytime in
the Cayman Islands, it’s nighttime in India. Therefore, during the day, the
Health City Cayman Islands doctors help monitor video feeds of post-operative
patients in India and quickly alert their colleagues at the slightest sign of a
problem. At nighttime in the Caymans, physicians in India return the favor.
4. Taking
advantage of scale
The higher the volume
of patients in a hospital and the more experienced the surgeons, the better the
care. When the volumes rise even more, physicians can sub-specialize in
particular operations, further improving quality outcomes.
But the advantages of
higher volumes are more than just higher quality. Higher volumes lower the
capital investment needed per patient and reduce supply costs. Higher volumes
help smooth out the daily variation in demand, allowing for optimal staffing
levels. And high volumes allow hospitals to expand their use of their
facilities into the evening and on weekends so teams of physicians and nurses
are more readily available, further decreasing the time to treatment.
To achieve “scale” –
that is, to enjoy the benefits of increased volume – Dr. Shetty is focused on
maximizing the productivity of his staff and utilization of his facilities.
And to blaze the
path, he sent his most experienced surgeons and nurses from India to Health
City. They understand what is needed to run the operating rooms and cardiac
catheterization areas 12 hours a day, 6 days a week, and deliver high- quality,
efficient care starting from day one.
The result is
productivity double that of the typical U.S. hospital.
What does
this mean for U.S. health care?
At the end of Dr.
Shetty’s ceremony, I asked him why others before him had not adopted the same
approaches.
“The future is in
front of them, but they can’t see it,” he said.
Based on everything I
saw in the Cayman Islands that day, the operational approaches in Dr. Shetty’s
hospital are about 10 years ahead of those used in the typical U.S. hospital.
It may take a decade
for him to complete his 2,000 bed construction and attract the volume of
patients necessary to fill each bed. But if I were the CEO of a hospital in
Florida, I would be rushing to match his outstanding clinical outcomes and low
prices today. Once Health City Cayman Islands is fully operational and filled
to capacity, it will be too late.
