ing of the new NH hospital on Grand Cayman Island,
the first in the Western hemisphere.
As we made final preparations for the pilot, I started
to make arrangements for my return to clinical residency. The timing worked out well. I had facilitated
the design process, but the coding, testing, and implementation would carry on without me. My final trip to
India that year centered on ensuring that my successors
were fully capable of taking the reins on this project as
I transitioned back to clinical residency.
A year later, after a successful pilot, the scaled-up
version of the product was available, and it now serves
as the primary chart in a Bangalore cardiac ICU. The
new NH hospital is open, and we all anticipate the software will be operating there soon, as well.
What I brought home
We had dreamed about a “smart” EHR, debated and
determined how it should work, revised our plans,
made compromises, and then, finally, built a product.
My greatest reward was seeing our creation put to use
in patient care. Surmounting the day-to-day challenges
of creating a definitive product that started out as such a
nebulous concept provided me with my greatest learning experience. I also learned a great deal watching
firsthand how Dr. Shetty managed his organization.
One major challenge was actually the mirror image
of NH’s biggest asset: the leanness of the organization.
NH is extremely disciplined about containing costs.
There is essentially no waste, no unused resource. As a
result, finding personnel and money was difficult, and
we succeeded because we had Dr. Shetty’s active support. I do regret, though, that we did not have resources
for an impact study to determine whether our software
measurably improves patient care. This may be a goal
we can pursue in the future.
Eighteen months later, what stands out about work-
ing with Dr. Shetty is how a surgeon’s leadership can
comprehensively influence the service a hospital deliv-
ers. For example, during close week, Dr. Shetty’s main
contribution was to simplify our design. He repeatedly
asked such questions as, “Do we need that feature? Is
that piece of data necessary?” One of the most power-
ful things he did as a leader was to streamline the pro-
cess and remove unnecessary and superfluous infor-
mation and ideas. Dr. Shetty is relentless about cutting
processes that require time and money but which fail
to enhance patient care. At the same time, he selects
important projects like the hospital’s infection control
procedures and dedicates his own time and influence
in order to advance them. His dual role as chairman
and an active surgeon who operates and sees patients
on a daily basis enables Dr. Shetty to make these types
I believe surgeon leadership can make hospitals
better. I have noticed that in addition to his personal leadership, Dr. Shetty selects senior physicians and
surgeons to lead new hospitals and other key business
units, which I believe is important to their success.
Excellence in hospital management boils down to overseeing thousands of details that experienced clinicians
That first day in the NH boardroom, I took note
of the sign mentioned earlier: “Healthcare is all about
Process, Protocol and Price.” In the following year,
I learned that these words do not signify that NH is
perfect. Rather, they keep the organization’s purpose
front-of-mind for its leaders, as an aspiration to be pursued every day.
It might serve us well in the U.S. to be similarly
focused. The lesson my experience at NH taught me
about successfully running a low-cost hospital is that
it requires extreme discipline and attention to detail.
I am grateful to Dr. Shetty and to Stanford General
Surgery for affording me this opportunity to build a
new product and, in the process, to observe NH operations at every level—from the ICU to the executive
suite. I anticipate that as a result of this experience, I
will be better prepared for a career of shaping organizations to deliver excellent, affordable health care. ♦
MAR 2015 BULLE TIN American College of Surgeons
EHR IN INDIA