Abstract:  To analyse the emerging business models and identify best practices which are contributing to sustainable development of healthcare. Literature review from published articles has been done to study various models and presented through this paper. The healthcare sector in India is undergoing a phase of reform propelled by rapid economic growth. There has been a significant growth in the healthcare sector over the past few years and is expected to reach USD 280 billion by 2020. 

  • The main growth is seen in low costs hospitals in Tier II, Tier III cities and rural India. Innovations that build on technology, ICT as well as private-public partnerships (PPP) are relatively more successful and a number of good examples can be found on the ground.
  • These along with specialized care hospitals represent the next generation of low cost rural healthcare and are developing quite rapidly.
  • The focus has now also come on process optimization, standardization and inclusive models to ensure long term sustainability and cost effectiveness.

 The paper attempts to identify some of the best practices adopted by the emerging business models in healthcare which are contributing to improved health outcomes with low cost and at the same time, remaining sustainable. Key words —Sustainable Development, Emerging Business models, Value in healthcare etc.

Online Digital Outpatient file in a teaching hospital
Satyashankar*,  Sumangala Bhat**, Nitinkumar Marathe***,  M Gopal****, Mruthyunjay G Salimath*****
SDM College of Medical Sciences & Hospital, Dharwad is a 900 bedded hospital with an average outpatient attendance of 1400 patients/day (range 1050-1950), with year to year growth rate of 15%.  Digitalisation of the outpatient medical record was started 16 months ago as a solution to the problems associated with the physical storing and retrieval of huge volume of records.  Most of these problems had a solution in this simple & cost effective method.
The Filmless hospital : 3 years experience in a teaching hospital
Satyashankar*,  Sumangala Bhat**, Nitinkumar Marathe*** 
Hospital wide PACS (Picture Archiving and Communication System) is a computerised electronic system which entirely replaces conventional x-ray film by acquiring, archiving, transmitting & displaying digital images on a network of workstations throughout the hospital1.
Early PACS were characterised by the use of very expensive handware devices, cumbersome display stations, lack of interface to other clinical information systems and high storage costs.  Today, computer power has increased and archival cost has decreased to the extent that the economics of PACS is justifiable with respect to the film2.
PACS was implemented in a tertiary care teaching hospital in November 2011.  Capital cost involved, Return on investment based on projected saving on film cost for the last 31/2 years, benefits & problems associated with the introduction of PACS is discussed.
A. Abraham*, S.Saldanha**, GJ Quadiri***, AR Rebello****
The need for appropriate, written documentation of facts related to patients’ treatment in the hospitals cannot be brushed aside, because failure to maintain records means failure of duty towards the patient. To evaluate Medical Records based on the National Accreditation Board of Hospitals (NABH) criteria, a retrospective study was conducted in Medical Records Department of selected teaching hospital in Karnataka. Medical records, belonging to General Surgery Department were included in the study. 450 medical records were randomly selected for this purpose. A checklist was prepared as per the medical documentation criterion laid down by NABH. The forms considered for the assessment were Admission record, Admission order, History sheets, Reference forms, Doctors forms, Consent forms, Pre-operative checklist, Anesthesia record, Operation notes, Nurses record, Medication record, Infection control form, Observation charts, Investigation charts, Hospital service record and Discharge summary. Though overall medical documentation process was satisfactory, Non-compliance was observed with regard to Admission consent(39%),Pre-operative checklist(28%),Drug record (20%) and Intake-Output chart(37%) and Investigation chart for entering requisition time and collection time(55%).
Since Medical records plays an important role in evaluating the quality of care provided, due importance need to be given to Medical Documentation. 
Medical Records, NABH standards, Documentation
DrPavithra LS*, Dr Amitha**, DrSomu G***
Introduction: OT linen includes surgical gown, lap bundle, drape bundle, trolley drape and other packages for each surgery. Usage of reusable OT linen in OT is prevalent in majority of Indian hospitals.Recently, usage of disposable OT linen is rampant in most of the private hospitals.  It has a higher advantage of reduced infection transfer to the patient and to the handlers as well. Disposable gowns are used only once and are good in providing protection; however, the problems associated with disposable fabrics are high-risk contamination, environmental issues through waste and landfill, expense, and discomfort if they are reinforced with a plastic film.1Reusable linen are usually more comfortable than disposable fabrics; however, reusable cotton fabric without a finish does not protect against bacterial penetration.2 Aim & Objective: This study aims to bring to light the strategies adopted in healthcare practice for improving the hospital acquired infection (HAI) rates and managing biomedical waste. The objectives was to study the change in hospital infection control rates by adopting innovative practices likedisposable linen as against recycling of hospital linen. The study also gives us a picture on the evolving waste management practices in healthcare all aimed at optimizing the hospital infection rate.Material &Methods: The study is retrospective with data collection over two time frames, (i.e.2009-10 and 2014-15) and involved data collection related to surgical site infection; volume of waste generated in using disposable gowns; tracking of Hospital infection and observation of changing practices. Chi Square test was applied to ascertain the statistical significance. Results & Conclusion: The study showed that the total number of surgical cases was about 22562 when using reusable linen and surgical site infection (SSI) during the period was 98. The total number of surgical cases done using disposable linen (2014-15) was 28571 with a total SSI of 78.Chi square test used to ascertain the significance showed p-value as 0.0019 (test of significance at p<0.05) which is highly significant. Biomedical waste generated was outsourced during the years 2009 onwards with the hospital paying based on number of kilograms of waste generated. However over the years the same has been abolished and the terms of payment have been fixed on the bed complement irrespective of the quantity of waste generated. Hence an increase in the volume of waste generated did not have any cost impact on the biomedical waste. The study brings to light that in switching over to disposable linen, there is a reduction (from 0.43% to 0.27%) inhospital acquired infection rate. Hence switching over to disposal gowns may be considered as a contributory factor towards control of Hospital acquired infection (HAI).
Key Words: Hospital Infection control (HIC); surgical site infection (SSI); Linen; Biomedical Waste management; Hospital Acquired Infection (HAI)
A. Marla*, Somu G**, Arun MS***.
The management of human resources in healthcare institution is essential to enable the delivery of efficient and effective medical services and to achieve patient satisfaction.
Human resource management (HRM) is the management of an organization's workforce, or human resources. It is responsible for the attraction, selection, training, assessment, and rewarding of employees, while also overseeing organizational leadership and culture and ensuring compliance with employment and labor laws. The future of HRM in healthcare promises to look very different, particularly in the way the workforce is sourced, organized and managed.
This paper is based on descriptive analysis to get an overview of the human resources management in healthcare sectors in current situation.
Knowledge and Attitude of Nursing Personnel Towards Organ Donation: an Exploratory Survey. 
L. Gopichandran1,Joshi Poonam1, Raghavan Srinithya2, Dabas Heena3, Xavier Teenu3, R Mahesh 4
Objective: To determine the knowledge and attitude of nursing personnel regarding organ donation in a tertiary health care facility. 
Methods: In an exploratory cross-sectional survey, a pre-tested and validated questionnaire on knowledge and attitude towards the cause of organ donation was self administered to 340 conveniently selected nursing personnel working in indoor facilities of medical and surgical disciplines of a tertiary health care facility. The data was collected and analysed from October 2014 to October 2015.
Results: Out of 340 nursing personnel enrolled,   majority were females (71.2%)   in the age group of 21-30 years (70.4%).  More than 50% of nursing personnel followed  Hindu religion(55.7%), and 62.6% were graduates.  Nearly half of the nursing personnel were working in ICU with the median present professional experience of 2 years (2 months -20 years). Majority of nursing personnel (66.9%) had not attended any seminar/workshop or class on organ donation and opined that they did not have enough information about organ donation and  wanted to attend training on organ donation (69.5%).  Majority of nursing personnel had moderate knowledge and attitude scores related to organ donation.  Mean knowledge and attitude scores of nursing personnel in the area of organ donation were 18.5 ± 3.6(2-27) and 77.9 ± 8.6(23-116) respectively. Weak correlation was observed between the knowledge and attitude scores of HCP (r= 0.135, p=0.013). No significant association could be established between the select variables and the knowledge and attitude of nursing personnel.  
Conclusion: Nursing personnel had moderate knowledge and favourable attitude in the area of organ donation. Nursing personnel should have formal in-service education and training on organ donation so that more appropriate promotion can be initiated.
Key words:  Knowledge, Attitude, Nursing Personnel, Organ Donation 
Perceived work stress among emergency nurses of a tertiary care hospital in north India.
LaxmiTej Wundavalli1, Anoop Kr Daga2, D K Sharma3, Suman Kashyap4
Introduction: Emergency Departments (ED) of hospitals are recognised hot spots for work place stress. A population based approach to identify the extent of specific stressors would enable the hospital to take action at the organisational level in a proactive way. Methods All the nurses working in the ED (n=114) were recruited into the study. The HSE Management Standards Tool was used to gauge the responses of nurses to work stressors along with a few questions on socio demographic characteristics. Results The response rate was 86 per cent. The top three stressors were demands, relationships and control which required urgent action. This was followed by manager’s support whose scores indicated a need for improvement. Those who had less than five years of experience perceived manager’s support and control to be significantly lesser compared to those having more than five years of experience. Males perceived manager’s support to be significantly lesser compared to females. The positive aspects were good peer support and role clarity among the staff. Discussion: The study attempts to quantify stressors among the ED nurses in an Indian setting. Overall, more than 50 per cent of the nurses’ experience stress in either of the seven dimensions of stress. The study identifies three major stressors that require attention on an organisational basis. There is an urgent need to assess the workload vis-a-vis the total nurses’ strength and address the supply gap. The domain ‘Relationships’ requires assessment on an urgent basis. Concerns of the staff regarding the nature of manager’s support sought need to be assessed in detail. Steps should be taken to identify burn out among nurses at an individual level.