Safdarjung Hospital, New Delhi in recent times has come under a lot of negative press for not being able to handle the dengue outbreak in Delhi and for its inability to provide patient care up to expected standards. However, this article reveals what Dr. Ashish Jha (Expert in International Health Policy & Managaement and also Director & Professor at the Harvard Global Health Institute) saw when he visited the hospital in October 2013.

145% Occupancy!
He begins by stating an important fact. The hospital has 1,531 beds and 145% occupancy! Yes that’s right 145%. This means bed sharing and even asking relatives to bring cots. Right across the street from Safdarjung is AIIMS, India’s premier institute but the differences between the two are glaring. While AIIMS has a long list of specialists, world class facilities and a great reputation Safdarjung doesn’t enjoy any of these advantages,its specialists are not well known and the facilities are not great.

The stamp of efficiency
However, by 11 a.m everyday the hospital has 7,000 people already in line for treatment. Roughly 50-100 people wait for anti-rabies serum, because most other public hospitals don’t have it. The hospital’s yearly workload includes: 800 cardiac surgeries, 2,000 angioplasties, 3,000 echocardiograms, and 100,000 ECGs. The hospital has only 4 full-time cardiologists, while the rest of the work is handled by medical residents. In comparison, Brigham and Woman’s Hospital which only sees 1/4th of this patient flow has 140 cardiologists! Patients at Safdarjung pay very minimal fee for treatment and medication is free. The poorest of the poor line up for treatment and different kinds of stents are mentioned on a notice board which looks like a menu.

Remarkably, the main point isn’t about how busy the hospital always is. It is about how well everything works in tandem without a halt or major breakdown. There is an ICU full of patients on ventilators with a single medical resident running the show. It is imporant to look at data relating to volume-outcome relationship. The hospital claims to have great outcomes and there’s no questioning it. When asked about the cardiac surgery mortality rates, the Chief of Cardiology candidly replies, “We are on par with international standards.” When Dr. Jha tried asking what ‘international standards’ were the chief got angry wondering if he was being accused of running a poor quality unit.

No Time for Data!
Data driven activities are the key to efficient functioning in every U.S hospital. Patient inflow, in-patient time, treatment period and outcomes are all measured and stored critically. Hospitals grants are received and taken away because of data that reflects quality service or mismanagement. But at Safdarjung, no one knows the latest evidence. No one has time for data!

The simple explanation – patients are always given antibiotics quickly, primary PCI is never delayed, non one ever went home without a beta-blocker, yet data is not tracked and the doctors don’t seem to mind because ‘care is being provided’. Dr. Jha marvels at Safdarjung hospital and says –

Safdjarung hospital is a marvel! It has huge volumes and clinicians who are clearly both incredibly talented and dedicated. It achieves 80% of the quality of U.S. hospitals at 10% of the cost.

Better than U.S Hospitals
Dr. Jha points out that while cost effective the quality is questionable, but not in a bad way! In India, the patient volume is so high that great quality is acheived but isn’t recorded because the job must go on! U.S standards obsess about cutting corners i.e taking shortcuts towards doing what is necessary without thinking and therefore doing so much with so little!

Safdarjung hospital is at a position where it is better than U.S hospitals. With 7000 outpatient visits and 400 inpatients everyday, it is a huge number! Simply by looking at EHR to assess patient quality and stopping assumptions good patient outcomes this hospital can change the very way patient care is perceived in India.

It would also surpass a majority of hospitals in the U.S. says Dr. Jha simply by adding private rooms and some decent food. Still making it cheaper than 85% of hospitals in the U.S!

Dr. Jha closees by saying – Safdarjung Hospital is an amazing place! A hospital that manages high volume, efficiently, delivering superior patient care while being stripped down to the bare minimum. He strongly believes, Safdarjung can very well be a case study to teach U.S hospitals on managing with the essentials. The hospital would be a model for hospital care in India and abroad on how to handle and deliver patient care via an efficient system.

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Original Post: An Ounce of Evidence | Health Policy (Blog by Dr. Ashish Jha- Professor of International Health & Director, Harvard Global Health Institute)

Image Credits – The Hindu

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