Where money is not the prime mover

Not a medical doctor himself but having received training in hospital management, Fahdel Sheikh is upscale Aadil Hospital’s owner and director. With a pleasant demeanor that might or might not have been an acquired attribute, considering that is a job requirement, he keeps involved with the hospital’s procedures and activities. While conversing with Profit, he was interrupted a few times to receive patient updates from several doctors, reminding them of the convalescent’s history and inquiring about their current status.

“My primary training was in business studies but I was always very clear that I am not going to limit myself to just that. So I specialized in health services and hospital management.” Hailing from a well-heeled family, his focus is on quality standards instead of using his hospital as a money-printing machine. That said, Aadil generates about Rs2 million a month in revenues. “For a hospital administrator, success does not emanate from popularity, it comes by putting in place a system that works even if he is not there. If it does, it is an accurate measure of effective management,” said Fahdel.

Health Care Managers: Trend comes to Pakistan

In the developed world, a statutory condition for hospitals is to be managed by healthcare managers. The trend is catching up here now. The new legislation requires that either trained hospital managers or similarly qualified doctors are in hospital management.

This raises the possibility of the managers being at odds with doctors. “The model that works best is to leave the job to professionals, with an effective oversight system in place. Some people always want to overstep the boundary, and that’s where the system comes in. The new healthcare law, called minimum service delivery standards, clearly defines those boundaries. It clearly dictates what a medical practitioner can and cannot do,” said Fahdel.

Fahdel has the same philosophy when it comes to the pharmaceutical provisions in the hospital. “We don’t have any pharmacy of our own because that is better left to professionals. We have a contract with Green Pharmacy, and we do have a drug enforcing committee ensuring supply of quality medicines and ensuring no sales to anyone without a prescription.

“Sometimes people appearing to be otherwise very decent claim to be my relatives or my father’s friends and try to snub the staff, but they are well trained to not to compromise. Even relations have to come to me first.”

Yet some people feel being wronged by the healthcare professionals. “The best solution is to try and bridge the gap through dialogue. The good thing about the latest legislation is that an unresolved issue goes to Punjab Healthcare Commission, and not a regular court. That Commission regulates all doctors and hospitals and evaluates the complaints about service delivery gaps on whether it was medical negligence on the part of a doctor, hospital, or if there was anything lacking during the process of treatment.”

Having his legal and medical problems solved through legal recourse, Fahdel concerns himself primarily with the managerial issues and maintaining the reputation of his hospital.

Steps in the right direction

Healthcare industry in Pakistan is growing, with the market being explored. Patients and clients are becoming more aware and demanding better services that are value for every rupee spent. “There is lot of space for more medical services. About 60 percent of Pakistan’s healthcare is being provided by the private sector, including some philanthropic institutions. Successive governments have failed to provide for and allocate necessary budgets for health care.”

However, he appreciates the recent developments at the government’s end, allowing for a more conducive environment for entrepreneurs to invest in the sector. “The recent reforms have taken the right step of privatizing the management and board of public hospitals. The ghost hospitals (Basic Health Units) in rural areas are now beginning to deliver services in an attempt to reduce the burden off the tertiary care hospitals in big cities. It may be too little too late but certainly a step in the right direction. The political appointments and red tape have meant the government hospitals underperforming and overburdened at the same time. This will change for good. The government will monitor the performance of these public hospitals and hold the autonomous boards responsible for delivery.

“The government has introduced standards and regulating bodies for implementation of these standards to include the Punjab Healthcare Commission (Minimum Service Delivery Standards,  Licensing of hospitals, handling complaints and monitoring quackery), and the Punjab Blood Transfusion Authority, in addition to pre-existing regulatory bodies like the federal regulatory bodies like Punjab Drug Authority, PM&DC & UHS.”

There still is room, he feels, for the government to play a bigger role in this sector through granting “more autonomy to the health sector, monitoring health indicators and paying those who (HCE) provide service to people.”

Speaking on the operational model for Aadil Hospital, he said, “Our model of service delivery is personalized care. We proudly say ‘Let your Health be our Concern’. Our focus is to provide affordable health care service without compromising on ethics.” Aadil Hospital provides subsidized health services, with the accent being on not to espouse a commercial approach. It is a 150-bed teaching hospital operating as a non-profit organization under the umbrella of Abdul Waheed Trust and under the parent company Genix Medical Services Pvt. Ltd.

Other projects of the Abdul Waheed Trust include Avicenna Medical College, Abdul Waheed Institute of Allied Health Sciences, Gulfreen Nursing College, Avicenna Charity Teaching Hospital, and soon to start Avicenna Dental College. Fahdel’s aims for the future include Avicenna Dental College becoming a degree-granting institution.

Top healthcare at one-third the rates

“We don’t do direct fundraising, but for Avicenna Hospital we channel the fees of the medical students, nursing students and technicians. The funds generated through the fees of the medical students are used for payments of salaries, utility bills, and for running the charity hospital. It is a self-sustaining, self-generating model which is also quite popular these days. The Trust has the support of doctors and Pakistani professionals working in the United Kingdom and Canada as well.”

According to Fahdel, Aadil Hospital offers the same service as the top hospitals in Lahore for 1/3rd the price. “Those who can afford even that can always get premium service for more. The idea is self-sustainability. As for Avicenna Hospital, the service is completely free.”

The value of service depends upon the need of the patients receiving the service and their social economic background. “In the government sector or the charity hospitals, the patients’ main focus is to access basic healthcare without barriers. The equation changes with the insurance company and corporate sector who demand more value for the service delivered for the insured or the employees of the company. One’s client teaches one everything. At the end of the day, a hospital has to serve the needs of the patients and differentiate the need from the wants; after all, one size does not fit all.”

There are patients who are constrained by their budget as opposed to those who look for brand names in doctors and exclusive rooms and foreign trained staff. Offering a right mix of service according to the need and want of the patient can be a challenge at times, considering that it is a buyers’ market. Aadil Hospital accounts for these premium services and makes them available for the wealthy at appropriate costs. “A digital x-ray can cost you Rs800 from a private hospital on average whereas the same is provided free by the public sector or a charity hospital. But the real question is whether someone is ready to go to a public hospital?”

Talking about keeping his hospital’s goals aligned with those of his staff, Fahdel said that the management believes in an open door policy resulting in a very low turnover rate. “We are happy to share the goals and objectives of the hospital with the department heads, staff members, paramedical staff and even the cleaners. All people in their own sphere understand and work towards the common good of the patient.” His HR department constitutes of members from all departments in the hospital and while hiring, prior to the interview, it ranks prospective candidates. “Proper background checks are made while the performance post-hiring is also measured at regular intervals.”

Regarding the operational budget for the hospital Fahdel said, “The expenditure depends upon the revenue collected and the demand for new services or redesigning the existing ones according to the new trends in the healthcare industry. The department heads bring in their demands with estimated outcomes, like an increase in the service range, and in direct and indirect sales. The budget is accordingly allocated to develop new services and acquiring equipment as per most pressing priority.”

Instead of marketing, Fahdel is focused on developing business through word of mouth, and so far, he says, he has been very happy. “For the last three decades, our hallmark has been to provide emergency services irrespective of the affordability of the patient. One satisfied patient brings in 10 more.”

Segregating emergency services

Talking about the challenges of his industry and the ways to overcome them, he said “We were constantly pressured to hire all-round doctors – now almost extinct as a human resource. So, we segregated our emergency services into an adult male, female and pediatric service round the clock. This is relatively a new trend in the private hospitals. We faced resistance from doctors but overall the quality of service improved remarkably, creating the ripple effect of patients being able to walk in 24/7 and getting a suitable doctor to attend to their immediate needs without having to go to a specialist.

“Though the return on investment may not always be great keeping up with the latest technology is essential to survive. Each year we have an outlay for new purchases of equipment and work out collaborations with industry partners to provide affordable and quality diagnostic solutions.”

The power bills are Aadil’s biggest expense, and Fahdel hopes to minimize these through a gradual shift to solar energy.

Aadil Hospital engages in philanthropic work, especially during times of natural disasters and national tragedies. On May 8, 2015, seven people died when a military helicopter on way to the inauguration of a ski resort chairlift crashed at Naltar near Gilgit. One of the seven casualties included the Philippine ambassador Domingo D Lucenario.

Aadil Hospital volunteered, “as it was as upsetting for us Pakistanis as much as it was for the countries whose diplomats died in that accident. We stepped in and to our surprise, the government was the last to respond and slowest to move. We offered our services to the Philippines embassy and within 24 hours we were able to identify and repatriate the remains of the late ambassador.”

“And then we started getting calls from other embassies to do it for them too. We were appreciated for that.” Embalming, packing, and sealing services were offered by Aadil Hospital at the CMH Rawalpindi for which the institution was appreciated by all foreign missions and the ministry of foreign affairs.

In December 2016, Fahdel became the first Pakistani to have been awarded with the Kaanib ng Bayan Award by the President of Philippines Mr Rodrigo Duterte for his dedication and services towards the Filipino community living and working in this country. In addition to this, Aadil Hospital is now also working with a couple of foreign missions for their medical checkups, free medical camps, and vaccination, including camps for the Philippines, the British High Commission, and Nigeria.