REPORT

“Aga Khan Hospital and Medical College Foundation”

SUBMITTED TO:

Mr. Naeem Aziz

Faculty Managerial Policy

SUBMITTED BY:

Nasima Abbas Ali

Karim Munir
Farooq Misbah
Saif Nathwani
Naheed Fatima
Muhammad Imran Shaikh

A report submitted to the Muhamamd Ali Jinnah University Karachi

In fulfillment of the requirements for

The Course “Managerial Policy“

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 Table of Contents

TITLES PAGE #
LETTER OF ACKNOWLEDGEMENT 3

EXECUTIVE SUMMARY 4

ABOUT HOSPITAL (Vision, Mission and Values) 5

MACRO ENVIRONMENTAL FORCES INFLUENCING

8
THE HOSPITAL

COMPETITIVE FORCES AND ITS DYNAMICS 12

SWOT ANALYSIS 14

HOSPITAL’S OVERALL PERFORMANCE 15

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 LETTER OF ACKNOWLEDGEMENT

November 13th, 2007

Dear Reader,

We are thankful to our instructor, Mr. Naeem Aziz of Muhammad Ali Jinnah University
Karachi for his valuable guidance and encouragement. His directions have certainly helped
us in completing this report in time. This study has not only helped us gaining in depth
knowledge of the subject, but has also enabled us to gain insight of Hospital way of
responding to external and internal environment.

We hope that the knowledge gained in this course would get along with us for long time and
would help us in our academic and professional lives.

The comments and suggestions about this report will be most welcome.

Sincerely,

Karim Munir Nasima Abbas Ali

SP06-MB-0049 SP07-MB-0114

Naheed Fatima Farooq Misbah

FA06-MB-0165 SP05-MB-0047

Saif Nathwani Muhammad Imran Shaikh

(FA06-MB-0194) SM04-MB-0027

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Executive Summary

This report is designed to have an insight on the external and environmental view of Aga Khan
University Hospital and SWOT analysis in detail.

Since the University is a multidimensional organization with various entities located at different
centres. We have limited ourselves to the Hospital section of The Aga Khan University Hospital.
The Hospital entity covers the Medical and Support Staff, Information Technology Divisions,
Maintenance which have been analyzed in this report.

The Leading and Controlling operation is somewhat common Institute wide therefore in this
report we have dealt with it in a generic format. However the Strategic Planning and Organizing
is Division specific which has been covered separately under the separate entities.

The University Administration have developed a 5 to 15 year visionary plan according to which
the strategic goals of the respective divisions have been planned and analyzed in the report. The
focus of the management as far as the Human Resources is concerned lies in the retention of
outstanding employees and reengineering the current work processes and methodologies and to
establish fair and equitable systems which proactively address and resolve the HR needs of the
Institution, as well as the faculty and staff, providing them with opportunities to achieve their
potential.

With Information Technology the senior management looks to be a University on the Information
Superhighway of the world and develop a support system which can help AKU achieve its
mission and vision. The senior management is looking at an information rich network which will
help students, faculty members and staff to provide on spot service and care to patients and
customers.

Through the University Administration entity AKU aims at excellent human resources and
advanced technology to support the skills of its staff and as the University claims its not the
financial resources which averse the Institute to go for new projects it’s the human resources
which the Institution feels should be there to cope with the demands of the new projects which
AKU takes up….

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Hospital Introduction1
Profile

Aga Khan University Hospital, Karachi, (AKUH) started operations in 1985, as an

integrated, health care delivery component of Aga Khan University (AKU). It is a
philanthropic, not-for-profit, private teaching institution committed to providing the best
possible options for diagnosis of disease and team management of patient care. AKUH's
multidisciplinary approach to diagnosis and care ensures a continuum of safe and high-
quality care for patients – all services under one roof.

This University Hospital has 542 beds in operation and provides services to over 38,000
hospitalized patients and to over 500,000 outpatients annually with the help of
professional staff and facilities that are among the best in the region. Care is available to
all patients in need. Those who are unable to pay for treatment, receive generous
assistance through a variety of subsidies and the Hospital's patient welfare programme.

AKUH is the first hospital in Pakistan and among the first few teaching hospitals in the
world to be awarded the prestigious Joint Commission International Accreditation (JCIA)
for practicing the highest internationally recognized quality standards in health care.
Similarly, the Hospital also holds ISO 9001: 2000 certification for practicing consistent
international standards of quality services.

Facilities

The Hospital is equipped to diagnose and treat Medical (including Cardiac), Surgical,
Obstetric and Gynecology, Pediatrics and Psychiatry patients and its inpatients have an
average length of stay of 3.6 days. The Hospital also provides comprehensive Oncology
Services including: Medical and Surgical Management, Radiation Therapy,
Chemotherapy and Bone Marrow Transplant.

A total of 542 beds, 122 private and 117 semi-private air-conditioned rooms, 251 General
Ward beds and 52 critical care beds are available in Intensive Care Unit (ICU), Coronary
Care Unit (CCU) and Neonatal Intensive Care Unit (NICU). The Hospital has 11 main
Operating Theaters. In addition to these, there are 4 Operating Theaters in Surgical Day
Care, 2 in Community Health Centre, 1 in Obstetric and Gynecology and 2 mini-theatres
in Section of emergency.

State-of-the-art Pharmacy, Radiology (including nuclear medicine), Laboratory,

Cardiopulmonary, Neurophysiology and Rehabilitation services are available at AKUH.
A fully equipped Emergency Room is open 24 hours a day with a Triage desk and Fast
Track System to ensure prompt medical attention for all patients.

1
http://www.aku.edu/AKUH/aboutus/intro.shtml

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AKUH Laboratory operates over 130 phlebotomy or specimen collection centers in
Karachi and all major cities of Pakistan. The Hospital also operates 9 off-site medical
centers (Integrated Medical Service Units) in various parts of Karachi. Home
Physiotherapy and Home Nursing and Health Care Services are also available in almost
all areas of the city. These off-site services are a part of AKUH's outreach programme to
facilitate public accessibility to quality health care.

The Hospital draws a large number of referrals from outside Karachi and Pakistan and
operates Patient Information and Referral Desks in Hyderabad and Quetta and a
Representative Office in Dubai, U.A.E. These offices provide assistance by coordinating
all necessary arrangements, including review of medical history by consultants prior to
the patient's arrival at the Hospital.

Mission, Vision and Quality Policy2

Mission

The mission of AKUH is embodied in a summary statement which is as follows:

 To provide exemplary care to patients;

 To develop and test innovations in care, education, and research;
 To support the teaching and research missions of the Faculty of Health Sciences;
 To contribute to the development of a system encompassing primary, secondary,
and tertiary care, and not geographically confined to the existing Hospital facility;
 To provide access for needy patients who may not, on account of financial
difficulties, be able to afford normal Hospital charges, and to reach out to those
who might not otherwise present themselves at the Hospital;
 To develop new services in response to public expectations as resources permit on
an economically viable and sustainable basis; and
 To carry out programmes and assigned missions in a manner that would
demonstrate the ability of the institution to attain self-support in a developing
nation environment.

Vision

"AKUH will be recognized as one of the best health care institutions in Pakistan and the
developing world. We will achieve this: By providing compassionate, ethical, accessible
and high Quality care that meets or exceeds the needs and expectations of our patients,
their families and others whom we serve.

2
http://www.aku.edu/AKUH/aboutus/mission.shtml

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  By providing an outstanding work environment that fosters motivation and
commitment in our staff.
 By enabling leadership in education and research that improves the health of the
people in the region."

Quality Policy

We at Aga Khan University Hospital

 Provide compassionate, ethical, accessible and high quality care that meets the
needs or expectations of our patients, their families and others whom we serve.
 Provide a work environment that fosters motivation and commitment in our staff.
 Enable leadership in education and research that improves the health of the people
in Pakistan.

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 Macro-environmental Forces influencing the Hospital

Economic Forces:

Cost Efficiency
The Aga Khan University Hospital is by birth the non profit organization, so it has to
maintain a very tight policy for cost control. The targets set are very tight and requires a
bottleneck to approve over budget. In many a cases because of highly skilled and trained
staff, costs are cut down even from the budgeted cost resulting favorable variance in that
entity.

Employment
Currently there are around 4,000 employees working for AKUH (which includes On and
Off campus activities, Human Development Program, Institute of Educational
Development, Faculty of Arts and Science), thus providing a very strong employment
ratio within the country.

Currency Exchange Rates

Hospital is directly influenced by increase and decrease in the exchange rates, all the
major medical equipment are imported from different parts of the world majority from
Japan, many of the staff are expatriate and their wages are paid in dollars so the cost
increase and decreases as changes in currency rates occurs.

Social, Cultural, Demographic and Environmental Forces:

“AKUH has had a direct impact on the quality of life and health care facilities in Pakistan
by providing an integrated array of state-of-the-art medical services and training
programmes,” observed AKU President Firoz Rasul on this occasion. “The first teaching
hospital in Pakistan to have achieved ISO 9001: 2000 certification, AKUH combines
high quality clinical service with compassionate, accessible and individualistic patient
care that meets the needs and expectations of society,” he said.

Mr Nadeem Mustafa Khan, Director General and CEO, AKUH, said that more than 1.3
million people hold a medical record number with AKUH while in the year 2005, nearly
1.5 million patients benefited from its services. Moreover, 432 residents were trained in
34 sub-specialties under the University’s Postgraduate Medical Education (PGME)
programme.

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Some of the attributes are as follows:
Muslim Culture
The Aga Khan Hospital provides a wonderful architect which reflects Muslim culture,
which includes Mosque, greenery, buildings, manuscripts, paintings, greeting messages
and all of the above with an aerial view collection of building denotes “Allah”.

Patient Welfare Financial Assistance

In keeping with its mission, Aga Khan University Hospital (AKUH) endeavors to provide
access to its medical services, to needy patients who may not, on account of financial
difficulties, be able to afford normal Hospital charges.

More than 70 per cent of the 410,000 patients who visit AKUH every year are from low
and middle income households. Often they cannot bear the full cost of their medical
treatment. In place since the Hospital was established, the Patient Welfare Programme
financially assists needy patients, regardless of religion, gender, race, color, creed or
domicile.

During its first year, in 1986, the Patient Welfare Programme provided Rs. 3.4 million in
welfare assistance. Since then, the need has grown dramatically. So far, Rs. 1.4 Billion
has been spent, benefiting over 250,087 needy inpatients and outpatients. One in every
four patients admitted to the General Ward is a welfare-assisted patient.

Medical Ethics
The medical staff provides services with respect for human dignity and the individuality
of the patient, regardless of age, sex, religion, social-economic status, or the nature of the
health problem.

The medical staff safeguards the patients’ right to privacy by protecting all information of
a confidential nature.

The medical staff acts as advocate to safeguard the patient and public when health care
and safety are affected adversely by incompetent, unethical, or negligent practice.

The medical staff is responsible for maintaining and increasing competence in nursing
knowledge, practice and skill.

The medical staff collaborates with members of the health professions and other citizens
in enhancing community and national efforts to meet the health needs of the society.

Education
Competitive medical staff required up to the mark training and knowledge of the
changing world medical practices, Aga Khan Hospital based an in-house University with
the name of Aga Khan University so that shortage of skill manpower could be overcome
internally.

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Conference and Seminars
Aga Khan Hospital is continuously arranging conferences and seminars to deal with
health issues, radio coverage in collaboration with FM-100 every Friday from 4.30 to
5.00 pm. Many seminars and symposium are arrange free of cost, just to bring awareness
to the common public well before eruption of the disease.

Pollution control and waste management

Aga Khan Hospital is spending lots of cost in pollution control and waste management,
Up to 2006 actual, Rs. 10/kg to KMC and Rs. 4/kg for in-house waste obliterate cycle.

Political, Legal and Governmental Forces:

Health Laws
Aga Khan Hospital is very much focused on the Health Laws provided by the
international and local bodies like World Health Organization, UNICEF, Pakistan Health
Association, and in this regard many international certificates were awarded like ISO
9001:2000 Quality Management System and Joint Commission International
Accreditation (JCIA).

Patient Rights
The website section for patients clearly indicates the importance of patients in view of
Hospital, one introductory sentence from AKUH website is as follows:

“Welcome to Aga Khan University Hospital (AKUH) and thank you for
selecting our Hospital for your healthcare needs. We are grateful to you for
the level of confidence you have placed in us”.

Environmental Protection Laws

Aga Khan Hospital is working very close with W.H.O. in environmental issued related to
Health care. The hospitals are required to create and maintain an environment friendly
atmosphere where healing could be done in less time as possible. In this regard Aga Khan
Hospital is having a separate division for maintenance of environmental attractions like
Pond, greenery, architecture etc.

Tax holidays
Government has announced 50% tax holiday on all the upcoming initiatives like Faculty
of Arts and Science, Institute of Educational Development in East Africa, more then 50
collection point through out Pakistan. During the emergency situation many a times
Government gave 100% tax exemption to entertain the sufferers.

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Technological Forces:

For maintaining Leadership position among many competitors requires some tough and
costly decision and to maintain a technological lead is very important these days, in this
regard Aga Khan Hospital is investing lots of money in acquiring and maintaining Up-to-
date technology.

PeopleSoft-ERP3
Aga Khan Hospital have acquire the license of PeopleSoft an Enterprise Resource
Planning (ERP) software at a very high cost, not only acquiring was costly but to
implement it in such a big organization was the main issue and requires lots of money for
it.

Up-to-date Equipment
In such a dynamic world where technology is changing and upgrading day by day, most
of the medical equipment earlier used became out dated, replacing this equipment
requires high cost but is bear by the hospital to maintain the standards and satisfy needs
of the customers.

Intranet
Aga Khan Hospital provides their employees all the information, self upgrading and
many other related news, training and development schedules, food recipes and much
more. All the forms like leave, medical claim, transfer, reimbursement etc are available
on the intranet. Many online training and quizzes are held once a month, to have an
update to staff. All this became possible with the uses of technology.

3
http://intranet/it/

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 Competitive Forces and its Dynamics within the Hospital

Human Resource4
Aga Khan Hospital has made a policy that it will not compromise on disability of human
resource, the selection procedure is very tough and recruit has to go into very tough
selection process before appointment. Aga Khan Hospital has very high job satisfaction
and retention ratio.

Trained Staff
On job training is one of the most important and noticed area of Aga Khan Hospital and
for that a special department with the name of Training and Development has been made
in 1992, staff had to complete at least 12 hours of on job training a year and is added in
their annual evaluation form.

Environment
Aga Khan Hospital environment is very much beneficial for internal and external both.
The working environment is very friendly and employees enjoy certain rights which even
cannot be assume in many corporate. For external users the hospital environment plays a
very vital role in recovery the lush green areas, the pond, the architect all gives away new
hopes of life.

Planning and Budgeting

The key to success of any organization is strategic planning, many corporate do three
years, many do five years but Aga Khan Hospital are only few of those which are doing
fifteen years planning. Many new initiative which are to be started in 2013 are already
planned today, another area is to convert plan into budgets, Aga Khan Hospital is very
much proud of having budgeting personnel of world class.

Accreditations5

Joint Commission International Accreditation (JCIA)

In September 2006, Aga Khan University Hospital (AKUH), Karachi became the first
hospital in Pakistan and one of the first few teaching hospitals in the world to be awarded
the prestigious JCIA for achieving and maintaining international quality standards in
health care.

AKUH submitted to a formal survey by the JCIA in July 2006. A team from the US Joint
Commission comprising of an experienced professional nurse, a physician and a hospital
4
http://intranet/hr/
5
http://www.aku.edu/AKUH/aboutus/accreditations.shtml

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administrator surveyed all elements of the Hospital's services. The results of the survey
demonstrated high levels of compliance against standards applied throughout the entire
facility.

JCIA is a division of the American-based Joint Commission on Accreditation of

Healthcare Organization (JCAHO). JCIA was created in 1998 to develop standards
applicable to the international community. These standards are organized around the
important functions common to all healthcare organizations. The standards are grouped
by those functions related to providing patient care and those related to providing a safe,
effective and well-managed organization. The survey process gathers standards
compliance information throughout the organization, and the accreditation decision is
based on the overall level of compliance found throughout the organization.

ISO 9001:2000 Quality Management System

In June 2000, AKUH became the first teaching hospital in Pakistan and one of the first
teaching hospitals in the world to receive ISO 9001:2000 certification for Quality
Management System for Patient Care and Support Services. Since then, the Hospital has
successfully demonstrated its focus on quality improvement in subsequent recertification
audits.

Marketing
Aga Khan Hospital being a non profit organization is expensing out very low on its
advertising, but has been surfing on many health care activities like what discussed above
about FM-100 program on every Friday from 4.30 pm to 5.00 pm, sponsoring many
international initiatives in Pakistan.

Benchmarking
Aga Khan Hospital, to maintain its leader ship position has set many bench marks with
respect to top world medical universities, and is achieving most of them and lots more to
be done.

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 SWOT ANALYSIS

Strengths Opportunities Strength v/s

Opportunities

 Capital  Health to all.  AKUH is using its

 Human Resource  Government expenditures capital and human
 State of Art Technology is increasing resource to increase
 Voluntarism  Interior areas health to interior and
 Off campus activities  Health horizons are niche markets.
 International Setups increasing.  AKUH is
 Quality Control  Expansion to another increasing it’s Off
 Maintenance continent. campus activities, and
 Central Control  Mobile hospital. increasing its paradigm
 Health Environment to many rural areas thus
 Planning and Budgeting attracting Govt.
Expenditures.
Weakness Threats Strength v/s
Threats

 High Medical Cost  Competitors.  Quality control, central

 High Maintenance Cost  Dynamic World. authorities and HR are
 High Staff Cost  E-hospital. very much responsible
 Zone of Tolerance is very  Surgeries using artificial for reduction is activity
small intelligence. cost by not
 Negative word to mouth  Tele-medicine. compromising the
 High inpatient’s ratio  Donor findings may quality.
leads to non personalized decrease.  Highly competitive
service  Inflationary pressure on staff and On campus
 Patient to Staff ratio is not price. training allows new
up to the mark  Uncertainty in political initiatives and threat of
 Emergency room is not conditions. robotic surgery can be
enough to satisfy needs  Govt. Regulations. minimize by starting On
 Appointment booking campus robotics
requires lot of waiting surgery.
period  15 years planning
 Many tests prior to allows organization to
admission look far beyond where
 Perceptions are not equal others can’t even
to Expectations imagine decrease threat
of rivals and

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 Hospital’s Overall Performance

Nasima Abbas Ali

(SP07-MB-0114)

The overall performance of the hospital in terms of

Educational Institution and as hospital is Exemplary; The
University is the first private medical school providing quality
education locally and internationally, as AKU is not only in
Pakistan but in different parts of the world.

Karim Munir
(SP06-MB-0049)

According to me, during this research and report writing I was

amazed by having such an institution in developing countries,
with world class standards and facilities, this was dream in
which I was in for about last one month and dream over I see
Aga Khan Hospital.

Farooq Misbah
(SP05-MB-0047)

We all know that Aga Khan University Hospital is the well

known Non-Profit earning Health Care Services and Medical
Science Education providing Organization in the world of
Health Industry. Therefore, it is obvious that as a Non Profit
Organization it becomes very difficult to manage the cost
cutting techniques, for helping needy patients arrangement of
funds, do better utilization of those funds, continuous tracking
of the donors, invest the fund in such a manner that can
generate revenue which can be utilized in different ways in
the different services of the AKUH.

Along all these issues related to AKUH, maintaining the

Quality services is a very critical job.

In view of the above, the suggestions can be given to AKUH

for keeping continuous enhancement in the Performance of
the Hospital:

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  Must hire line of good Consultants / Doctors who has
the ability to satisfy the patients with calm, honestly
and above their expectations.
 In-Order to overcome the Maintenance Cost, AKUH
can outsource the work for which they are not
competent enough to perform efficiently.
 AKUH must keep track on their Weaknesses and do
not enter in the era of success arrogance.
 AKUH must capitalize their key opportunities
 On the basis of those Opportunities develop Strategies
with the vision which benefits AKUH in the long run.
 External and Internal Assessment should be the
continuous process.

Saif Nathwani
(FA06-MB-0194)

AKUH is performing very well in the health sector of

Pakistan. AKUH is performing its role at its own, along with
private and foreign agencies and with government agencies.
AKUH is fulfilling its promise of providing better health
facilities and healthy environment at hospital. Committed and
professional staff performs there duty to provide good health
care to the patients. AKUH has a name in the world health
industry for providing excellent health care and treatment.

AKUH adopts latest technology for the treatment of patients

and is involvement in awareness programs for safe and basic
health in rural areas shows its commitment.
Medical college and school of nursing are producing well
professionals who are contributing in the field of health. In
short AKUH is performing its all duties and responsibilities
very well and is contributing its part in the health industry and
has become a role model for other institutes who are operating
in the same field.

Naheed Fatima
(FA06-MB-0165)
AKUH work as a self driven force towards health and mainly
appearing before even the diagnosis of any uncertainty, it is
working very well with Government and is also providing a
good resource for foreign exchange.

Muhammad Imran Shaikh

(SM04-MB-0027)

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One of the most important area of concern to tourist is health
care and they have a faith on AKH gives an ultimate
advantage to economy of Pakistan. The health facilities
provided here a no more less then of international standard.

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