Working with tertiary care facilities
It's harder than it might appear at first blush, but the rewards are very worth it
My latest project has me working with Tertiary Care Facilities in New Delhi. Which is, not to be unfair to them or my work, very interesting, but at the same time, it’s incredibly frustrating. They are places doing some of the most thankless work for those most in need while being perennially understaffed. That deserves a lot of credit. At the same time, that perennial understaffing leads to lots of problems in operations and management.
The data from these locations is amazing
Public tertiary care facilities tend to have large numbers of patients. It is something people in India experience quite closely if they’ve been to a public hospital, but the sheer scale can be quite mind-blowing. The AIIMS nephrology OPD saw nearly 100,000 visits in 2021. Extrapolating that number to the entire OPD tells us that AIIMS treated close to a million people in its OPDs alone. Sure, some of them are repeat visits, some of them are now inpatients, but still, the number ought to give anyone pause.
And this is, of course, before looking at other public hospitals such as Safdarjung Hospital, Lok Nayak Hospital, or Dr RML Hospital. Not only do they provide tertiary care to patients but all these hospitals are teaching hospitals as well. People from all over India flock to these places to get tested, diagnosed and hopefully cured, giving these hospitals an unparalleled look at the disease profile of a modern Indian.
The systems are battle tested
The systems set in place in these locations are all battle-tested. They have to be, given the number of patients who go through them. That’s not to say they don’t have bits that can be improved: being battle-tested does not make them immune to criticism. However, I do not have to wonder what’ll happen in case a public hospital in Delhi gets overwhelmed. The systems tend to be overwhelmed all day. That is their default mode of functioning.
The hospitals are overflowing with people of all ages and social backgrounds. And when I say overflowing, I mean overflowing. They’re literally sitting in the hallways and spilling out onto the sidewalks.
The same cannot be said about the major private hospitals. Their prices tend to make them prohibitive for the common man to walk in through the door and demand treatment, unless of course he or she has an insurance plan in place. However, they too have many many patients queuing outside the doctor’s door waiting for a consultation.
Prioritisation is always a problem
However, this set of characteristics make these systems fairly brittle. While overwhelming them is difficult, changing them also, by necessity, is difficult. They have been hyper-optimised to function in a particular manner. They function so as to ensure that their existing mechanisms do not break down under patient load. This often leads to these hospitals reaching short-term optima at the cost of long-term optimisation. Asking a large public hospital to introduce a new set of tests for a population will always remain a herculean task because the sheer quantity of resources they would demand for the same.
This problem of prioritisation extends to resources beyond the physical. A doctor’s time tends to be one of the scarcest commodities in the country. India has one of the lowest number of physicians per capita, with 6 physicians per 10,000 people as per 2023 numbers. Asking a physician to allot a minute more than what they currently do becomes a major ask, with most hospitals asking you to justify the need.
The problem of a minimum viable solution
This style of functioning forces you into thinking about minimum viable solutions. Can you replace a CAT scam with an X-ray? Can you put in some test which can be performed by an orderly instead of requiring a doctor? Can you bring in AI? Will your doctor trust the results the AI gives him or her?
And more importantly, it forces you into rethinking your problem set. Is my problem set actually worth it? At whom should I target this? Does the average person visiting a public hospital in Delhi really require the solution I’m peddling? Does my solution solve a problem which this population actually cares about?
Answering these questions in the backdrop of some of the world’s busiest hospitals is a challenging task. But onwards and upwards! These questions are worth answering, so the only way is forward.