Amity Journal of Management Amity Business School

Vol. V, No. 1, January - June 2017 Amity University, Madhya Pradesh (ISSN 2347 – 1832)

A CASE STUDY ON SHREE KRISHNA HOSPITAL

Dr. Raju M. Rathod 1 Dr. Yagnesh Dalvadi2

ABSTRACT

The performance of any hospital largely depends on efficiency of Human Resources in Hospital. Health care
sector is becoming more competitive. All the players in health care sector need to maintain very high
standard of health care services to survive and sustain in the market. Shree Krishna hospital (managed by
Charutar Arogya Mandal trust) is the most preferred hospital. The hospital got high rank in part of central
Gujarat which is known as Charotar Rigion. Professionalism and accountability are the primary focus of
Krishna hospital. For last one decade hospital is facing problems of fund as hospital is providing services at
highly concessional rate. Shree Krishna Medical charge very nominal fees of registration and consultation.
In general wards, hospital provides free stay and diet food to the patients. It manages all emergency case
with utmost care. Shree Krishna Medical gives some special benefits to the people who are living below
poverty line. To compete with the present standard of health care service quality in India, Shree Krishna
Hospital needs major improvement in employees’ capability to serve its patients. It spent its entire training
budget to impart training to its medical practicing doctors. One of the major problems faced by Human
Resource head is how to train hospital staff including executives, officers, clerical staff, technicians, nursing
staff without sufficient budget. With a paucity of budget, HR department started behavioral and soft skill
training for employees on limited basis. At present one of the crucial issues for HR management is how to
signify the impact of these limited training imparted to staff and sustain this programme for exploring and
enhancing human resources of hospital.

Keywords: Human Resources, Health Care Services, Behavioral Training, Training & Development.

INTRODUCTION Maintenance, Personnel and Administration,

Project, Quality improvement, System,
In the month of October, 2014, Human
Nursing service, Operation, Patient
Resource Department head of Krishna
relationship division of organization.
Hospital, Mr. Suresh Rajagopalan called
meeting of his HR team members to convey He stated to his team that hospital is facing
the concerns and expectations of top problems of fund as we are providing
management of organization. He said it is services at highly concessional rate. He
high time now to think about designing some emphasized to improve the efficiency of
robust plan to improve the efficiency of 1000 human resources of hospital to serve their
plus employees working in Audit, Account, patients and maintain high quality standard.
Customer Relationship, Business Hospital spent its entire training budget to
Development, Corporate Communication, impart training to doctors. As training to
College Administration, Extension Activity doctors directly influences the health care
Staff, Material Management, Medical Record, service quality and it is at priority of the
Central Research Service, Library, hospital. One of the major problems faced by
Human Resource head is how to train
 Professor, G.H. Patel P.G. Institute of Business hospital staff (non doctors) including
Management, Sardar Patel University, Vallabh
executives, officer, clerical staff, technician,
Vidyanagar-388120, Dist. Anand, Gujarat
Email: [email protected],
nursing staff without sufficient budget.
M- 9825271352 About Organization
 Professor, P.G. Department of Business
Studies, Sardar Patel University, Vallabh Shree Krishna Medical is managed by
Vidyanagar 388120, Dist. Anand, Gujarat, Charutar Arogya Mandal (CAM). Charutar
Email: [email protected], Arogya Mandal was established 36 years ago
M- 9828799455 as a venture of hope, to offer comprehensive,

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compassionate healthcare to everyone and About Parent Trust
anyone who needed it. Over the last three
Charutar Arogya Mandal (CAM) was a
and a half decades, millions have walked
dream project of late Dr. H M Patel, who was
through the doors of Shree Krishna Hospital,
Union Finance and Home minister at that
looking for a cure to some of the worst
time. CAM established 3 decade ago to
diseases of our time. Without exception,
provide medical services to the rural
every one of them received world class care.
community of the Charutar Area which is at
Without exception, every one of them paid
the heart of Gujarat State. Hospital had
only what they could. It’s their commitment
grown along with state of art facilities with
towards seeing the humanity in people,
affordable fees. The vision of CAM is to offer
rather than their bank accounts that makes
comprehensive and personalised healthcare,
this possible. Professionalism and
delivered with commitment, compassion and
accountability is the primary focus of
at the most affordable cost to all those in
organization. The hospital is situated in rural
need of it. In the year 1972 CAM registered as
area, even though affordability and efficiency
society and public trust. CAM focuses on
is highly maintained.
three aspects viz. Medical Facilities to the
Physical Environment of Shree Krishna patients, research in the field of medicine and
Medical is very pleasant. Shree Krishna medical education. CAM run full fledge
hospital is the most preferred hospital, medical college, called Krishna Medical.
managed professionally which gives hospital
Vision
a higher rank in Gujarat. Shree Krishna
Medical charge very nominal fees of "We want our institution to shine as an
registration and consultation. In general example of what the profession of medicine
wards, hospital provides free stay and diet has to be; noble, deeply rooted in providing
food to the poor patients. It manages all solace to the suffering and continually
emergency case with utmost care. Shree upgrading itself to further its ability to serve
Krishna Medical gives special benefits to the humanity."
people who are living below poverty line. Core purpose
There are more than 1000 employees who are "To provide and prepare resources for
working in this organization. Hospital is modern and professional healthcare to the
functioning in the field of medical treatment, community equitably."
research and education. Hospital has 550
plus bed with all kind of healthcare facilities Core values
including Cancer Care department with Core value of CAM includes four aspects
affordable charges. The facilities available Commitment, Excellence, Honesty &
round the clock by the professional team of Integrity.
doctors equipped with latest technology. It is
offering comprehensive healthcare services at CAM would strive to be a Centre of
an affordable cost and its service is available Excellence in all that we do; patient care or
for 24x7. The fundamental strengths of teaching, research or extension. It offer world
hospital are competent professionals, State- class health care services without
of-art technology and medical infrastructure, discrimination and the management believe
personalized and prompt outdoor services. poor person should not be prevented to get
treatment due to lack of money.
The organization is running its training
programs to improve the overall quality of Services at Krishna Hospital
service and to empower the employs. The
There are many services and facilities
present case is on exploring inputs generate
available in Krishna Hospital which includes
through quality enhancement programme.
General Services, General Specialties,
There are many Human Resource related
Laboratories Imaging and Critical Care.
issues which has been discussed in this case.
Krishna hospital also has general ward and

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privilege ward. The General Services compensation which they get from
intended to provide quality care to patients organization. Hence the main constraint of
and to ensure satisfaction which ultimately organization is that it cannot provide
results in meeting the expectations of the lucrative salary to its employees. This results
community. There is no registration or in the low motivation of the employees. So
consultation charge for the General OPD the real challenge is to motivate supportive
services. Privilege services include silver and staff for taking initiatives and offering
silver plus services with additional facilities efficient services.
like air-conditioned rooms with television
Another major disappointment is that
and attached toilet & bath.
employees who are at leadership cadre or
Challenges faced by Human Resources responsible to lead his/her team are not
Department taking any initiative in mentoring employees
The Human Resources Group continues its who are reporting to them. Employees are
efforts to help employees develop their reluctant to follow standard operating
personal and organizational skills and service process. They found to be very casual
abilities. Hospital is regularly gathering in their approach. Employees who have been
inputs from the professional development working form last 10 years or more in the
group to strengthen Continues Professional organization considered the hospital as
Development activities. The HR group is the typical bureaucratic government hospital.
single-point of contact for all campus Employees have not been found good in
institutions to facilitate developmental corporate communications. They even didn’t
activities. know the fundamental principles of
communication. Employees don’t know the
Human Resources Department team consists basic principles and techniques to do
of five personnel led by Mr. Suresh effective communication through electronic
Rajagopalan while all Continuous medium.
Professional Development activities have
been coordinated by Mr. Nigam Madan. As a There are many functions in the hospital
part of brain storming exercise Mr. Suresh where integration and coordination with
and Mr. Nigam discuss about the need of other department is required. But employees
training and practical possibilities of are not considering their department as a
conducting training for administrative and team and therefore are not working as a
technical staff with the help of some team. They are not able to perform their task
professional trainers who are ready to serve in coordination with other departments.
on voluntary basis. There is less organizational commitment
towards hospital among employees as they
It has been observed that employees are are trying to get better job elsewhere or
lacking professionalism in their approach trying to migrate in some other country.
while dealing with patients in the hospital. Employees are not enthusiastic to know more
Organization is located in rural area about basic fundamentals of health care
therefore it is difficult to get professional services especially business and service
staff. Organization is not able to provide very etiquettes. In this condition it is very difficult
impressive compensation to employees and to engage employees particularly in training
cannot attract talented professionals of health and development activities. Top
care sector. It is very difficult to sensitize management wants supportive staff to be
administrative and supportive staff (other trained. HR department must take some
than doctors) to develop patient centric initiative to enhance efficiency of supportive
approach. Employees are not satisfied with staff.

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 Exhibit- -I: Divisions/Departments (Other than Medical and Doctors)

Sr. No. Divisions/Departments No. of Executive/

(Other than Medical and Doctors) Officer/ Head
1 Account 03
2 Audit 01
3 Customer Relationship 08
4 Business Development 03
5 Corporate Communication 03
6 College Administration 03
7 Datary service 01
8 Extension activity 12
9 Fund Raising 02
10 Guest Relation 01
11 Hospitality Services 04
12 Human Resources 05
13 Material Management (Purchase) 09
14 Medical Record 01
15 Central Research Service 04
16 Library 02
17 Maintenance 11
18 Personnel and Administration 08
19 Project 03
20 Quality improvement 09
21 System 09
22 Nursing service 02
23 Operation 02
24 Patient relationship 02
Source: Annual Report 2014-2015, http://www.charutarhealth.org/about-us/annual-reports, retrieved on 1 November 2016

Exhibit-II: Staff Details as at March 31, 2015

Gender Full Time Part Time Consultants Volunteers ( Unpaid)

Male 657 36 39 Nil
Female 688 2 22 Nil
Source: Annual Report, http://www.charutarhealth.org/about-us/annual-reports, retrieved on 1 November 2016

Difficulties to Run Behavioral Training soft skill enhancement training programme

Programme for administrative and supportive staff.
Basic challenge of running behavioral and Hospital is providing concessional rate
soft skill enhancement training programme health services worth Rs. 8 Crore every year.
for Administrative, Nursing and other staff Human Resource Department is unable to
(staff other than doctors) is lack of fund. The manage funds for training of staff including
basic business model adopted by administrative staff and other support staff.
organization is to charge higher price from Management could not provide any budget
high income customer by offering them for training especially for administrative and
privilege service in which they need not to supportive staff (other than doctors).
wait and revenue generated through this Hospital kept budget of 30 lakhs for training
privilege services has been passed to poor but it was entirely spent to arrange training
patient. Organization cannot allocate programme for doctors. Training for doctors
sufficient budget to conduct behavioral and has been given priority because quality of

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doctors directly influences the health care and it would be difficult for them to shift
services. Some adjustment has been made their attention from work to learning
from other budget like travelling budget and sessions. Employee suffers from
allowance to arrange some necessary training preconceived negative mindset which does
for supportive staff in special case else they not allow them to attend such training
don’t have any funds for Training to the sessions positively.
support staff.
It is very difficult to adhere to the monthly
The major concern of management, while schedule of such training programme, as
taking decision to run continuous learning sometimes very poor response is received
programme is loss of working hours. Full from potential participants. Sometime
day training during working days is not because of some critical emergency
practically possible because most of the programmme has to be cancelled or
employees are engaged in emergency postponed. There is tremendous amount of
services. During holidays employees are not diversity among employees as they belong to
ready to attend such training programmes. different departments and nature of their job
Training during the working hours is different. There is much diversity in
negatively impacts the quality of services in employees’ demographic profile in terms of
terms of prompt response to patient. age, gender, experience etc. At the end of the
day it is very difficult to measure and justify
Employees may not take this continuous
the outcome of these training programmes.
learning programme very seriously as they
are not habituated to attend such programme

Exhibit-III: The Distribution of staff according to salary levels as at March 31, 2015:
Slab of gross salary including benefits paid to staff Male Female Total
Less than Rs. 5000/- 23 32 55
Rs. 5000/- to Rs. 10000/- 215 217 432
Rs. 10000/- to Rs. 25000/- 207 244 451
Rs. 25000/- to Rs. 50000/- 150 146 296
Rs. 50000/- to Rs. 100000/- 72 30 102
Above Rs. 100000/- 65 43 108
Total 732 712 1444
Source: Annual Report, http://www.charutarhealth.org/about-us/annual-reports, retrieved on 1 November 2016

Exhibit-IV: Income and Expenditure (Rs. In Lakhs)

Particulars 2014-15 2013-14
INCOME
Medical Care
Treatment Income (Net) 5,209.89 4,868.59
Grants 19.82 36.61
Donations From Community 176.09
Other income 74.49 57.52
5,304.20 5,138.81
EXPENDITURE
Medical Care
Manpower 2,268.77 2,220.62
Cost of Material Consumed 2,376.60 2,137.63
Administrative and other overheads 1,249.18 1,116.28
Depreciation 649.02 540.49
6,588.57 6,014.92
Source: Annual Report, http://www.charutarhealth.org/about-us/annual-reports, retrieved on 1 November 2016

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Exhibit-V: Administrative and Other Overheads (Rs. in lakhs)
Particulars As at 31.03.2015 As at 31.03.2014
(i) For Medical Care
Electricity 195.14 172.89
Postage & Communication Expenses 11.39 10.82
Advertisement & Publicity Expenses 22.54 8.38
Security Expenses 63.48 45.01
Printing & Stationery Expenses 83.29 66.30
Other Administrative Expenses 155.38 129.78
Interest on overdraft and term loan 224.92 232.94
Repair & Maintenance 448.46 400.16
Provision for doubtful debts for Shree Krishna Arogya 44.58 50.00
Trust
1,249.18 1,116.28
Source: Annual Report, http://www.charutarhealth.org/about-us/annual-reports,retrieved on 1 November 2016

Exhibit-VI: Other Income (Rs. in lakhs)

Particulars As at 31.03.2015 As at 31.03.2014
(i) From Medical Care
Income from Investment 3.90 0.13
Miscellaneous Income 70.270 56.35
Profit on sale of assets 0.32 1.04
74.49 57.52
Source: Annual Report, http://www.charutarhealth.org/about-us/annual-reports, retrieved on 1 November 2016

Exhibit-VII: Deficit (Rs. in lakhs)

Particulars As at As at 31.03.2014
31.03.2015
(Deficit) For the year (1,209.57) (875.16)
Interest transferred from Corpus Fund & HM Patel Centenary 117.92 124.97
Corpus Fund
(Deficit) Carried to Balance Sheet (911.65) (750.19)
Source: Annual Report, http://www.charutarhealth.org/about-us/annual-reports, retrieved on 1 November 2016

Exhibit-VIII: Income Expenditure summery (Rs. in lakhs)

Particulars 2014-15 2013-14
Income 166.99 166.87
Expenditure 53.40 51.95
Surplus of Income over Expenditure 113.59 114.92
Source: Annual Report, http://www.charutarhealth.org/about-us/annual-reports, retrieved on 1 November 2016

Exhibit-IX: Overall Deficits for Six years are as follows: (Rs. in Lakhs)
Years 2014-15 2013-14 2012-13 2011-12 2010-11 2009-10
Deficit for 1,029.57 875.16 1110.17 1383.18 1040.21 1220.54
the year
Source: Annual Report, http://www.charutarhealth.org/about-us/annual-reports, retrieved on 1 November 2016
Training and Development function at treatment, research & education. It is a Multi-
Crossroads specialty hospital having 550-bed offering
More than 1000 employees are working in comprehensive healthcare services at an
this organization. Hospital has over 31 years affordable cost. HR department talked about
of experience in the field of medical their concerns and constraints to some
professional trainers who were ready to

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serve on voluntary basis. Since October 2014, of various practical difficulties such as non-
Hospital is running two hours short duration availability of trainees, non-availability of
training programme for its limited employees, clash of training schedule with
employees. In last two years, 22 such training other important tasks, non-availability of
sessions have been conducted. The primary training auditorium sometimes etc. This
objective of running such training programme is not going regularly. However
programme is to improve the overall quality it has been consistently organized for last
of service and nurture professional approach two years despite of all such difficulties.

Exhibit-X: Behavioral Training Schedule for the year 2016

Cadre Training topics Hours
Nurses and Communication Skills 6
Paramedical staff Team Building & Team Work 6
Time Management 6
Personal Grooming & Etiquette 6
Stress Management 6
Conflict Management 6
Leadership for Nurses 6
Technical staff Interpersonal Skills 6
Team Building & Team Work 6
Stress Management 6
Personal Grooming & Etiquette 6
Clerical staff Communication Skills (Written) 6
Team Building & Team Work 6
Personal Grooming & Etiquette 6
Managerial Leadership (For Executives) 6
Team Building & Team Work 6
Stress Management 6
Class-iv Employee Personal Grooming & Etiquette 6
Source: Primary data collected from HR Department of Hospital

among supportive staff of hospital. Budget HR department collected feedback from

constraint is the major hurdle for arranging trainee at the end of each training session.
training programme frequently. In the Trainee participants have been asked to rate
beginning short duration training sessions 10 criteria measuring effectiveness of training
have been organized with the help of programme in 5 point scale where 1 is
professional trainers who are ready to serve strongly disagree, 2 = Agree, 3 Neutral, 4 =
without any honorarium. Disagree and 5 means strongly agree. Ten
criteria are as follow.
Organization intended to strengthen the soft
skills of its employees in various key areas 1. Training Meeting expectations.
not only to make them better professional, 2. Training Objective met
but also better human being at large. Strive to 3. Training contain relevant and easily
achieve the overall development of understandable
employees; Krishna Hospital has been 4. Subject Knowledge of Trainer
organizing various behavioral intervention 5. Training Environment and Friendly
programmes for last two years. Hospital trainer
intended to organize behavioral training 6. Class Participation and Interaction
programme or various cadres of employee 7. Seating and Room Arrangement
focusing at enhancing their core 8. Audio Video Support
competencies during calendar year 2016 also. 9. Training Time
Schedule for such training programme has 10. Usefulness of Learning
been prepared for the year 2017, but because

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 Exhibit- -XI: Training Sessions Organized in last Two Years
Sr. Date of Title of Training No. of Target Cadre
Training Participants
1 19.Sep.14 Service With Smile 34 Front Office Staff
2 26.Sep.14 ABCD of Change Management 26 Executives
3 10.Oct.14 Recharge Yourself 29 Office Assistants
4 17.Oct.14 Recharge Yourself 20 Executives
5 21.Nov.14 Learn to Lead 29 Office Assistants
6 28.Nov.14 Learn to Lead 21 Executives
7 19.Dec.14 Recharge Yourself 26 Executives
8 23.Dec.14 Recharge Yourself 18 Office Assistants
9 16.Jan.15 Learn to Lead 15 Office Assistants Pharmacists
10 06.Feb.15 Stress Management 10 Office Assistants
11 13.Feb.15 Change Management 23 Executives
12 27.Feb.15 Learn to Lead 16 Executives
13 27.Mar.15 Recharge Yourself 13 Front Office Staff
14 24.Apr.15 Learn to Lead 12 Office Assistants
15 29.Jul.15 Team Building 17 Executives Office Assistants
16 25.Sep.15 Stress Management 32 Technicians
17 29.Sep.15 Stress Management 18 Technicians
18 20.Mar.16 Celebrating Self 10 Office Assistants
19 12.May.16 Teamwork 25 Office Assistants
20 24.Jun.16 Teamwork 15 Office Assistants
21 15.Jul.16 Grooming & Etiquette 37 Technicians
22 22.Jul.16 Grooming & Etiquette 27 Technicians
Source: Primary data collected from HR Department of Hospital

Exhibit-XII: Measurement of Training Programme Effectiveness

Sr. Date of Training Module 1 2 3 4 5 6 7 8 9 10 Avg.
Training
1 10.Oct.14 Recharge Yourself 4.5 4.25 4.12 4.37 4.75 3.87 4.12 4.62 4.12 4.62 4.62
2 17.Oct.14 Recharge Yourself 4.42 4.32 4.74 7.74 4.89 4.63 4.32 4.37 4.37 4.37 4.58
3 28.Nov.14 Learn to Lead 4.21 4.16 4.26 4.37 4.63 4.42 4.37 4.32 3.89 4.21 4.32
4 21.Nov.14 Learn to Lead 4.26 4.17 4.35 4.43 4.61 4.43 4.13 4.30 4.35 4.43 4.30
5 19.Dec.14 Recharge Yourself 4.35 4.59 4.41 4.47 4.70 4.09 3.97 4.05 4.13 4.20 4.19
6 23.Dec.14 Recharge Yourself 4.25 4.27 4.12 4.46 4.51 4.11 4.01 4.14 3.99 4.9 4.38
7 20.Mar.16 Celebrating Self 4.60 4.40 4.70 4.60 4.50 4.30 4.50 4.70 4.60 4.80 4.50
8 27.Feb.15 Learn to Lead 4.37 4.30 4.38 4.49 4.65 4.26 4.20 4.35 4.27 4.39 4.41
9 13.Feb.15 Change Management 4.28 4.33 4.28 4.44 4.78 4.17 4.28 4.44 4.33 4.44 4.39
10 27.Mar.15 Recharge Yourself 4.25 4.00 4.33 4.42 4.58 4.17 3.83 4.08 4.25 4.50 4.33
11 06.Feb.15 Stress Management 4.50 4.50 4.80 4.70 4.90 4.70 4.40 3.80 4.70 4.90 4.50
12 16.Jan.15 Learn to Lead 4.53 4.40 4.87 3.93 4.60 4.60 4.60 4.53 4.27 4.67 4.47
13 25.Sep.15 Stress Management 4.30 4.20 4.50 4.77 4.77 4.43 4.27 4.07 4.60 4.73 4.60
14 29.Sep.15 Stress Management 4.27 4.32 4.68 4.59 4.28 4.27 4.18 4.09 4.32 4.64 4.50
15 12.May.16 Teamwork 4.30 4.22 4.61 4.48 4.61 4.39 4.65 4.35 4.30 4.35 4.35
16 24.Jun.16 Teamwork 4.13 4.07 4.33 4.20 4.27 4.20 4.64 4.00 4.00 4.33 4.20
17 15.Jul.16 Grooming & Etiquette 4.26 4.26 4.35 4.35 4.52 4.04 4.00 4.26 4.30 4.74 4.17
18 22.Jul.16 Grooming & Etiquette 4.23 4.12 4.43 4.34 4.47 4.21 4.44 4.20 4.20 4.47 4.24
Average 4.33 4.27 4.46 4.45 4.64 4.29 4.27 4.26 4.28 4.49 4.39
Source: Primary data collected from HR Department of Hospital

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It can be concluded that such training Assignment Questions
programme are fulfilling expectations of I. What are the major challenges and
management and meeting training objectives. concern of Human Resource
Training content was found to be relevant department of Krishna Hospital?
and easy to be understood. They were also
II. How to sustain the Continuous
satisfied with the subject knowledge and
Professional Development (CPD)
level of interaction with the trainers. Training
programme for supportive and
infrastructure was found to be well
administrative staff at Krishna
organized. Employees perceived that such
Hospital?
training sessions are useful for them to
improve. III. What are the various other ways than
training to explore and enhance the
HR department shared insights gather
efficiency of human resources at
through feedback with top management but
Krishna Hospital?
top management raised one valid question
that what is the impact of such training IV. How does Human Resource
programme? Do you have any documentary Department measure the impact of
proof which shows significant change in the training on the performance of
performance of employees before training employees?
and after training? Thus now Mr. Suresh and V. Suggest appropriate training module
Mr. Nigam again disused with HR team that and training methods for behavioral
how to establish linked of training and soft skills enhancement in health
programme and its positive impact on the care sector.
performance of employees. So now there
were basic two questions faced by HR head Mandatory Reading
is how to sustain and improve such training Smith, Bucklin & Associates, The Complete
programme? How to signify the impact of Guide to Nonprofit Management, John Wiley
such training programme in future? And Sons Ltd, 2000.
***

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