Ruby Hall Clinic | Technology Titans who lead from the front

Ever since its inception, Grant Medical Foundation’s Ruby Hall Clinic has its pillars deep-rooted in superior patient care. While one part of this is because of the expertise of the doctors, another part is because of their continued investment in state-of-the-art technology. Six decades later, this facility has retained its reputation of providing world-class care with advanced medical equipment. Dr. Manisha Karmarkar who has shattered the glass ceiling to become Ruby Hall Clinic’s first woman COO speaks at length about her growth trajectory, the hospital’s success story and her changing role in times of a global healthcare crisis.

Could you tell us about the success story of Ruby Hall Clinic and elaborate on its services?

Ruby Hall Clinic traces its deep roots back to the year 1959 when it first began as a two-bedded nursing home. Over the years, it has become a brand synonymous with technologically advanced quality healthcare and sprawls across a 600 bedded structure in the heart of Pune along with a 130 bedded unit in Wanowrie and a 70 bedded one in Hinjawadi. In addition to this, the hospital has 28 full-fledged diagnostic units across the breadth of Maharashtra.
We’re one of the only hospitals in the country with nine quality accreditations and certifications by the Quality Council of India in Healthcare. Housing a team of close to 4000 members, our doors are open to lakhs of patients each year. With over 40 specialities and sub-specialities, there is virtually no part of the human anatomy and mind that our doctors don’t care for.
Be it cancer treatment with advanced surgeries and the world’s most advanced linear accelerator, or even housing the city’s most sophisticated one-stop breast clinic with the Senographe Pristina Mammography machine, a 3T MRI with a breast coil and even the provision of Vacuum Assisted Biopsy, we have it all.
From SPECT-CT to 3D laparoscopy, advanced IVF, robot assisted procedures with the daVinci Surgical robot and advanced urosurgery, vascular care, ENT, interventional cardiology and paediatric procedures — our experts are well versed with the nuances of challenging procedures to ensure you get the best results. We’re also a nationally accredited centre for organ and bone marrow transplantation and have some of the highest success rates in the country.

The healthcare industry is seeing a number of changes. What is your hospital doing to stay ahead of these changes?

Out of every crisis, a new opportunity arises. For telehealth, it may be an opportunity whose time has finally come. In the last two years, we had commenced virtual services for those requiring specialist attention whether they were patients living in Nigeria or those from Dhule, a remote town of Maharashtra. The spike in coronavirus cases in India made the availability of this service all the more important.
But this is just one aspect. With telehealth comes the added benefit of remote monitoring, and while our intensivists have already been honing this skill, the pandemic has paved the path for other specialists to follow suit as well. Additionally, our hospital is also deploying the strengths of artificial intelligence (AI) to better patient outcomes — be it in radiology for quicker diagnoses or to improve patient satisfaction as a whole.

At a time when the country is grappling with COVID, what steps has Ruby Hall Clinic undertaken to manage the influx of coronavirus patients?

The first priority was getting our hospital ready and making sure that we had what we needed to keep our staff and patients safe. We became persistent in fine-tuning our daily planning strategies and tactics based on the fluid nature of the outbreak while maintaining the highest level of integrity and transparency. To be specific, here’s what we have been doing:

• Segregation of COVID positive patients:  We vacated an entire building within our hospital premises and used the space solely for COVID-19 patients keeping the rest of the areas infection free.
• A COVID task force:  We put together our team of experts in infectious disease, emergency medicine and emergency management who worked closely to keep our staff safe while caring for all of our patients that are impacted by COVID-19
• A dedicated Operation Theatre for COVID positive and non-COVID patients:  As an added precaution, we also prepared a dedicated OT for patients who tested positive. Our OTs are fully equipped with with HEPA filters and an independent AHU while maintaining a standard temperature. In fact, we maintain a high air exchange cycle rate of at least 35 air changes per hour to effectively reduce the spread of any virus. For all laparoscopic surgeries, we have a comprehensive smoke evaporating system to absorb aerosols.
• Virtual services for asymptomatic patients:  We offered telehealth services from our experts for those who have been quarantined at home, but still need care that’s equivalent or close to what they would get in a hospital.
• Emergency screening protocol:  We ensure that every person entering the hospital premises is checked for possible COVID-19 exposure with “no-touch” thermometers. If someone with a symptom is detected, they’re is escorted via a dedicated route to our Flu OPD for further assessment.
• Robust Disinfection Practices:  We have put into place enhanced disinfection measures while cleaning OPD rooms, high-contact surfaces and equipment every 2 hours. In fact, we have actualised an entire infection control team to keep close vigilance.

How has your role as a leader changed in the midst of the pandemic?

As a leader, it has been essential to be both proactive and reactive when it came to dealing with this pandemic. COVID-19 has affected the world and global healthcare systems on a multitude of levels and while it’s necessary to treat patients infected today, it’s also important to consider long-term implications on the continuum of healthcare as a whole. As an anaesthetist, I have led by example, performing procedures on COVID positive patients day-in and day-out. After all, my duty as a physician will always be towards my patients’ health. Taking a cue from my example, my medical teams too stepped forth to perform their duties.

For my staff, coronavirus presented a fear I haven’t seen before. I found that the most important thing is to listen to those fears, to acknowledge them, and to encourage resolve by being present; by wearing the same mask. I emphasised learning in this unique situation. I emphasised transparency – we’re together, we’re learning, we’re constantly changing.

Could you highlight how the hospital supported employees at such a time?

We at Ruby Hall Clinic undertook a number of measures to ensure our staff remained healthy and safe in times of this pandemic. These included:

• Clarity of communication:  Members of the COVID Task-force consisting of top management, doctors, infection control specialists and administrative staff met every single day to discuss updates, delegate activities and review protocols
• Provision of safety equipment:  Having had the opportunity to watch how other countries had to struggle for PPEs, we ensured the availability of PPEs, right from N95 masks and full face shields to head covers, gloves, full sleeve waterproof gowns and shoes. All staff is trained to don and doff these in designated areas only.
• Provision of quarantine spaces:  We provided quarantine facilities for our frontline workers within the vicinity of the hospital. Herein, we’ve made arrangements for accommodation as well as food.
• Psychological well-being:  In order to alleviate burnout and anxiety, we actively scheduled duties and rotations to give our teams the rest they deserve. We also allotted counsellors to help keep staff morale high and stress at bay.
• Continued education:  We conducted a host of in-house and national level webinars and individual sessions on infection control and ventilation techniques among others.

Recently we have noticed that healthcare organisations have started relying on technology to a large extent; what is your opinion regarding the role of technology in transforming healthcare?

The fact that technology and healthcare are interdependent is not new — healthcare needs spur the development of new technology, and in turn, technology improves healthcare delivery. Moreover, concepts such as wearables, artificial intelligence, IoT and telemedicine are not new terms in the healthcare sphere. Although their reception has previously been lukewarm, as the world grapples with a new way of life and the COVID-19 crisis peaks, we’re increasingly looking at healthcare systems and people turn towards technology for solutions.
Remote monitoring is here to stay, and we expect it to become the standard of care for our most vulnerable patients in the face of this pandemic. The impact of AI, IoT, and other technologies through natural language processing (NLP) and machine learning (ML), is also transforming care delivery. From diagnosing diseases faster, to continually monitoring patients, and even remaining virtually connected to patients and their healthcare records, we’re inevitably turning towards technology to transform healthcare for the better.

Could you share with us your vast experience in the healthcare domain, both as a clinician as well as a management professional?

A journey that started 25 years ago when I was still finding my feet as an anaesthetist has culminated into me leading the same organisation in the capacity of the COO. It was in the year 1995 that I started my career as a Senior Registrar in Ruby Hall Clinic’s Intensive Care Unit (ICU). Two years later, I was recruited as a consultant in the Department of Anaesthesiology. It was from there that I slowly began the climb up the ladder. While my skills as an anaesthetist grew, I was eventually appointed as the Director – OT Services at the main branch of Ruby Hall Clinic while performing the same duties at both satellite centres of the hospital.
It was during this time period that my interest in the field of medical management increased tenfold and the hospital’s CEO, Mr. Bomi Bhote saw potential in me to be a leader. I was given the challenging task of holding the reigns of Ruby Hall Clinic Wanowrie as COO and immediately grabbed the opportunity. In the following years, we changed the healthcare landscape in Southern Pune with this high-tech boutique centre.
Recently, I was trusted with the role of COO at Ruby Hall Clinic’s main centre at Sassoon Road. The rest, as they say, is history! I have the incredible chance to lead an organisation which combines my three lifelong passions: my love for medicine, the ability to empower all those around me and create a healthcare environment that focuses on clinical excellence, quality care and patient satisfaction.
Along with pursuing my duties as COO, I’m still a practising anaesthetist as well as head robotic surgery and a state-of-the-art breast centre at the hospital. Along with this, I play a key role in the financial management of the organisation and am responsible for the profit centres.

What advice would you give to other female leaders?

There’s a favourite quote of mine from Eleanor Roosevelt which reads, ‘One’s philosophy is not best expressed in words; it is expressed in the choices one makes, and the choices we make are ultimately our responsibility.’ While many of us have believed passionately in women leaders for many years, now is a time for action. My advice to female leaders would be: Believe in yourself and your potential.
For all of the women reading this, let’s choose to be a force to reckon with. This means connecting the dots to preserve our legacy, promoting our colleagues, taking on a mentee and making their success a necessary part of our own, tackling the systems that are inadvertently holding us back, and be really good at what we do. We are not weak, we are not whiners, we are trailblazers.