Shubhang Arora, First-person: Managing Hospital amid a swirling storm of highly Contagious Pandemic
By Neeraj Bajpai
On a sultry morning, He was sitting in lush green lawns of his South Delhi residence, answering calls on his constantly ringing mobile while being engaged in an urgent meeting with experts on the Zoom to fix a problem at his super-specialty hospital on borders of the national capital. It does not look like that the day has just started unfolding and is time for sipping a steaming cup of coffee.
Without losing cool, the young #Shubhang Arora, executive director of the hospital, ever since he has come from the United States after completing his advanced studies in business management, is neck-deep involved in handling a plethora of problems, emanating in the wake of raging pandemic coronavirus. But he is not tearing a hurry to rush through things, a cool way of handling issues is his hallmark of the style.
When approached for interaction as a first-person account of the situation, He steals a few moments from the hectic schedule for a virtual Coffee @newsabode program
“For me to manage health care facilities in our coronavirus pandemic stressed super specialty center was a challenge with a difference in more ways than one. But right from the beginning, meticulous planning was ensured at every step of the operation so that speedy care be provided for faster treatment and discharge of patients to pave way for beds others in the queue” he quips.
The number of new infections in India is tipping over 300,000 per day and more than 2,18,000 have died from the infection, although many there believe the figure could be a lot higher, he said the situation warrants cool handling with Himalayan patience and this applies to all may it be front line warriors, patients or planners. And “Compassion is the key” with a hand holding humane approach, junk all commercial considerations for a while.
He is of the view that due to the uncertainties involved, COVID-19 played havoc with everyone’s mental frame, more than physical, health. It is a vicious mind game! And need meticulous planning at every step. And I am no exception. So my advice is to be cool and compassionate.
According to him his personal struggle with COVID-19 seems meaningless compared to what my compatriots are experiencing, but there are some positives.
Initially, COVID-19 patients were treated as untouchables, and society shunned them. But now, people are helping each other. There is a sense of solidarity and I have heard plenty of stories of compassion involving friends, neighbors, and strangers
For the young entrepreneur, the current phase has changed his perspective and now I understand the real value of life. It is important to live life to the fullest and spend time with your loved ones and my parents, back up support, is immense so I am able to sail through this rough sea of problems.
According to #shubhang Arora, The stark realities of the monstrous pandemic were staring at us, and we were groping for solutions and the foremost task was to develop robust and sustainable architecture with an involved team of warriors.
Answering a wide range of questions, he said, The most positive thing that COVID has ushered in is that we have all come out of our silos, and on every day we toyed with new management skills to emerge unscathed in this unprecedented crisis. It has taught many lessons to face more complex situations.
Encapsulating the developing situation, he said towards the end of 2020, COVID-19 cases started declining and it looked as though India had conquered the pandemic. And while the world was praising India for its victory over the virus, the country was preparing to start the world’s largest vaccination campaign.
Narrating the turn of events, Arora, dressed in his casuals, said at times it looked as if the end of the pandemic was in sight and life was returning to normal. The markets and malls were buzzing with activity. Precautions were still being observed on a large scale, but people were beginning to get careless. This was the lull before the storm! But now you see, what is happening. Pressed to comment on super speeder events, He gave a terse reply, “is there any point to deliberate on split milk”.
According to him, everyone must appreciate that the situation is very dicey and any lowering of guards at any level will land anyone in a deep life-threatening situation.
He says prolonged outbreak lead to the progressive spread of disease with rapidly increasing service demands that virtually overwhelmed the capacity of the hospital, so managing hospitals in times of high risk of infection and an abysmal plunging of revenue is the biggest challenge that we faced and many others are facing the similar situation.
“We all understand that hospitals are complex and vulnerable institutions, dependent on crucial external support and supply lines. Under normal working conditions, many hospitals frequently operate at near-surge capacity. Consequently, even a modest rise in admission volume can overwhelm a hospital beyond its functional reserve and trigger a slew of challenges and we, too, are no exception.
On his planning at the hospital, He said,” Faced with such gigantic task, we all appreciated the problems. Firstly, we delegated powers to the staff so that leadership is built up and that worked, the foot soldiers in the confines of the hospital quickly shouldered responsibilities and the empowerment of staff was a magic wand.”
We chose to lay thrust on the state of the art pathology section and it was provided with the latest diagnostic tools so that cultures of the samples are done fast for precise diagnosis and results for follow-up treatment.
Within a few days, it was noticed the approach paid off and patients’ stay in the hospital was getting shrunk in terms of days.
Maintenance of the essential laboratory services is necessary for the appropriate clinical management of both pandemic and other patients, as well as for the hospital-based surveillance of the pandemic. We established a laboratory for the identification, confirmation, and monitoring of COVID-19 and laid thrust on an in-house RT-PCR testing facility with results on a real-time basis.”
Stoking his black jet well-combed hair, Shubghang says,” During the crisis, we laid thrust to be vigilant on availability of oxygen through the strict protocol for oxygen audit. While ensuring that drill, we had a lurking inkling in the mind that during this coronavirus-driven pandemic, to keep alive patients on life support system must be sustainable as response time to medication is a bit longer.
Given the latest mutant tendency to lower oxygen really put pressure on the oxygen supply but that timely handling of the issue, has come as a big help for patients, gasping for the oxygen, he adds as if every figure and facts are on his fingertips.
“In the wake of the massive influx of patients, availability of beds really emerged a major challenge, but the hospital staff was accommodative enough to adjust a maximum number of patients in whatever space available in the dedicated section.
Strict compliance of recommended COVID-19 protocols helped contain the spread of the virulent virus with routine fumigation, liberal use of sanitizers, detergents, and fast-changing of sheets and other infected listens for frequent washings.
Other main aspect was the development of leadership at the ground level as working hours are overstretching and fatigue is setting in. Under the stressed situation, a new breed of leaders sprung up and handholding with each other was very helpful to cope up with the situation where any let-up is still elusive.
That was like a nervous breakdown scenario, but instead of succumbing to multifaceted pressure. We remained unfazed, Thanks to the staff as they remained with the system like rock-solid support.
Amid paucity of resources, and scared staff, we gathered our nerves to lead by example to infuse confidence into the stressed staff and hopeless patients and their crying relatives. Scare factor was emerging as a major damper in planning but as team spirit developed, the scare was dissipated.
Psychological stress and mental trauma, coupled with fits of anger from both patients and their concerned relatives, was another big challenge for us to handle. The staff and senior doctors, while fully appreciating their concern and anxiety, counseled harried groups and even staff also to cope up with the situation.
At times, we had to convince serious patients that nothing would happen to them so that they develop mental strength to fight out, but our leaders were in a very veiled way articulating seriousness so it should not come as a sudden shock. The approach helped and no one resigned to the hopeless conditions till the last breath.
Because of the work pressure of stretched hours of working, the staff was facing physical and emotional stress and we, while planning took this aspect and remained in touch with the staff for a speedy solution of any problem. One thing that was haunting us that financial resources were draining as regular patients were not coming and elective surgeries were kept in abeyance and there was no time frame for any let-up. We chose not to give up, come what may.”
He made it clear though vaccines have come looming threats of fresh waves and new variants, our leaders, who encountered blood-chilling nightmarish experiences, are of the view that no country can afford to lower guards in the changing world. For them, the pandemic is still far from over and prevention – like wearing of masks, washing of hands and social distancing norms, etc. is better than the cure.
Our Yashoda super specialty hospital in Kaushmabhi, located on the borders of the national capital, caught the imagination of people and in some sense that created an additional load on the facility as patients are coming from various parts of the country, mainly from far-flung areas of UP.
Our traditional and time-tested wisdom was that a well-functioning hospital incident management system is essential for the effective management of emergency operations. Given the enormity of the workload, the Adhoc IMS does not work to the desired levels. We focused on the IMS as an essential ingredient for the effective development and management of the hospital-based systems and procedures required for successful COVID-19 response.
“We considered including representatives from the Services dealing with: Clinical, HR, Nursing, BME, Purchase, Pharmacy, Laundry, Food and Beverage, Transport and remained in touch with them on regular basis.
The engagement of assets, ventilators, and the short staff was another challenge but it was done efficiently without rubbing anyone on the wrong side.
We are trying to ensure that the hospital must have basic supplies and equipment to cope up with the situation where the safety of the front-line warriors was as important as the lives of pleading Patients. Our focus riveted towards PPE kit supplies and the availability of ventilators, vaccines and drugs required in the COVID-19 protocols “, he said while narrating operations at the hospital.
He says, the situation is getting compounded during the fresh wave as patients also needed emotional support. Relatives are not around and they are apparently unaware of the amount of mental pressure of the stressed staff, but all such things are being tackled with a humane touch –may it be breaking of news of a death on phone.
“We noticed the staff was getting encouraged when they saw us on their sides and open to their new and at times freak ideas. Our visual presence –may it be physically or virtual-was giving them an extra degree of confidence. In the crisis situation, the comfort level was building up between professional medical staff and other staff members and such a situation produced an amicable situation.
While handling tough tasks in the hospital, we are keeping all channels open to communicate with worried relatives and the public, in general, to ensure that they strictly follow announced protocols to keep themselves safe as well as the society in panic-like situations.
We handled the challenge of keeping ourselves abreast with the changing SOPs/guidelines from the Govt/WHO/ICMR. The situations are changing rapidly and so are the ways of dealing with it.
We activated a process to pick up relevant data coming in the media so that any information can be used . The data was especially in reference to positive cases, patients with comorbidities, clinical manifestations, deaths, recovered, etc.
While convincing staff for the rational use of assets, we also focused on our old patients so that base is not eroded during the crisis. It is tough but the telemedicine and virtual interaction came in handy for them “
There is a sense of solidarity and I have heard plenty of stories of compassion involving friends, neighbors, and strangers.(#Shubhang Arora)
The first wave separated loved ones, and although the second has brought people together, there is not a single home in India where COVID-19 has not cast its oppressive and ominous shadow.
As individuals and as a country, we are all working with a spirit t of solidarity and we all stand together in this hour of grief and challenge. The crisis is far from over so are challenges…….
Shubhang Arora, First person/Shubhang Arora, First person/Shubhang Arora, First person/Shubhang Arora, First person
Shubhang Arora, First person/Shubhang Arora, First person/Shubhang Arora, First person
(Mr. Shubhang Arora is Executive Director, Yashoda super specialty hospital, Kaushmabhi,NCR/ New Delhi)
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