Reportedly one of the biggest service providers for healthcare in the US, the Sodexo Group already has a leadership position in India’s healthcare sector. On a recent visit to the country, Stuart Winters, CEO Healthcare – Asia Pacific, Sodexo Services Asia gave an overview of Sodexo’s healthcare business globally while Sambit Kumar Sahu, Director – Healthcare India, Sodexo On-Site Service Solution spoke about their plans to add value to public health facilities through their year old partnership with HLL Infra Tech Services Limited (HITES)
How big is Sodexo’s healthcare business globally?
Stuart Winters: Sodexo’s healthcare business turnover globally is just under Euro 5 billion per year. While Sodexo operates today in 80 countries, within healthcare, we operate in 38 of these 80 countries. From a labour and talent point of view, we’ve got just under 80,000 employees who work for us in the healthcare segment and around 6400 on the consumer side at individual sites around the world.
Sambit Kumar Sahu: From an India point of view, Sodexo Healthcare’s journey in the country started around 1998. Today, we have a leadership position in India when it comes to on site solutions that we provide to the healthcare space both in the government and the private sector. We are at 45 locations spread across India. Some clients in India include AIIMS, Delhi and JIPMER. And in the private sector, Sodexo Healthcare is spread across all the brands like Apollo Group, Fortis, Manipal, Max, apart of course from the very old contracts we have with hospitals like Lilavati Hospital, Mumbai.
Our services offered to the healthcare segment look after various needs of patients, visitors and hospital staff. These include management of food services, laundry services, front office management, housekeeping, patient care. We also manage the technical support services related to engineering. We are also venturing into the clinical technology management services which is biomedical equipment maintenance as well as infection control. Sodexo self manages these services with its own office, whether its people, process or SOPs. There are different commercial models that we have for our hospital clients.
Could you give more details of your association with HLL Infra Tech Services Limited (HITES) to provide integrated facility management in public hospitals. The Gorakhpur tragedy when many babies lost their lives due to poor management clearly shows that there are many gaps when it comes to procurement and equipment maintenance practices in this space.
Sahu: We realised that being in the leadership position in this space, there is a clear requirement with respect to patient safety when it comes to the government sector. This is a pain area, not just from a procurement point of view but post procurement. Whether it is an ambulance, CT, MRI, etc, there are enough funds being spent by the government or a health organisation but what is really very appalling is that this equipment is not being used. Either people do not know how to use it or a minor fault in the equipment leads it to being not prepared on time and finally the patient has to do without it.
Today, there is a willingness in the government to outsource these services. They have realised that they themselves cannot manage it. And all these services, whether it is food services to start with, or clinical technology management, everything has to be outsourced. That is the mandate of the government today and we are seeing this happen in the last couple of years. And Sodexo does not want to miss this opportunity because we have the right solutions, global know how, technology, and talent within the country and the region. So we are in the right position to leverage this and get those solutions here.
We did not have very many government hospitals to start with. But we realised that there was an absolute synergy between HLL Infra Tech Services Limited (HITES), which is part of a Government of India enterprise under Ministry of Health & Family Welfare, and Sodexo Healthcare. They have their strengths, in terms of procurement as they are the largest procurer of biomedical and other equipment. They build hospitals and then continue to manage it or hand it over to be managed.
Our due diligence showed we had synergies with HITES in the central government space. We identified value added services like clinical technology management, maintenance of biomedical equipment, laundry services, environmental services, housekeeping and patient care. These are three-four key focus areas which we are working on together. Based on this, we signed an MoU last year.
Winters: In this context, it’s important to note that today, partnerships in business are becoming increasingly important. And we see the value of these strategic partnerships all over the world. It’s about bringing the best of two, three and sometimes even four organisations together to bring a service to a client. And not restricting your ability to deliver or service a client just because you may not have that skill in-house. That’s where the partnership with HITES is bringing true transformation in the way we deliver services.
One of your main clients in the public health space is AIIMS Delhi. What were the pain points, how did Sodexo Healthcare address them and what are the outcomes of your services?
Sahu: At AIIMS Delhi, we started mechanised cleaning for the whole campus of around 200 acres in December 2016. HITES and Soxedo realised that the pain point was productivity of output of the cleaning services. The facility was not well maintained, there was no training of the resources which was resulting in a poor image for a premier institution like AIIMS Delhi. HITES and Sodexo’s solution was to mechanise the cleaning process rather than continue with the prevailing manual cleaning method, which is generally used at most hospitals. We brought in state-of the-art equipment, mechanised the whole cleaning processes, got our SOPs into place. Within three months, we could see the campus turning around in terms of cleanliness of the premises of the campus. In fact, AIIMS Delhi got an award for cleanliness of the campus, which is a true recognition of the value of our services.
But it doesn’t stop there. Maintenance of biomedical equipment, infection control protocol and management, especially in the critical areas like operation theaters and ICUs remain the key pain points. This is where Sodexo can leverage its expertise. Today, we manage six JCI- accredited hospitals and 20 NABH accredited hospitals in the country. So, we have adapted these offerings from global to Indian requirements. We are in a position to further refine and adapt these offerings for Central Government hospitals so that they can work towards accreditation as well.
Winters: For us, it is about looking at it from a risk perspective especially when it comes to hospital acquired infections (HAIs), and focussing on the tools, SOPs, training, follow up ordered and as an outcome, the analytics. Anything that we deliver to the marketplace needs to have analytics behind it so that we can prove it. I want to make sure that Sodexo is known for having the best services in the market with the data and analytics to back it up.
What are the other futuristic and innovative technologies that Sodexo has implemented globally and in India?
Sahu: In the healthcare sector, we are an integrated facility management service provider. So any non-core activity which can be outsourced is outsourced to us and they look at Sodexo as a solution. Whether it food, laundry or patient care services across departments, it has to be seamless and integrated. Only when its integrated, will you be able to drive productivity, manage costs and deliver patient satisfaction to the level that you want. For this, obviously you need the right technology and tools. Sodexo has these solutions to manage the complex healthcare sector.
How cost effective are these solutions?
Winters: For me, it doesn’t come at an extra cost. It comes as an understanding of the way services should be delivered. I look after all of Asia Pacific and I’ve seen pockets where the traditionalists in service delivery just cannot change their mindsets. Its a labour driven market, so its easy to get 300 cleaners, and as long as each of them has a mop and a bucket in their hands, they are satisfied.
I think the world is changing. Productivity improvement is playing a very big part. Labour is becoming very difficult to acquire, train and incentivise. So the use of technology to improve labour productivity is key. So we don’t talk about it as being a cost to the business but as a differentiated approach to the market, a differentiated service offering with improved outcomes. And that needs to be key. We cannot continue to talk about improvements, cost efficiencies without also talking about the improvements that new systems bring. So its a balanced approach.
And governments are getting there. They are understanding the importance of productivity using technology. A cost addition in one part of the hospital could bring savings in another. So look at the total cost of operating rather than just at individual services.
Could you give an example?
Sahu: The biggest pain point in the healthcare sector in terms of talent management is in nursing. Hospitals report a 40-50 per cent attrition level of nurses, who are very skilled staff. But if you actually break down the tasks of a nurse in India, 50 per cent of the job is non-clinical. Almost 40 per cent of these tasks can be taken care of by patient care attendants. Sodexo trains, certifies and puts n place these patient care attendants, helping nurses to focus solely on core clinical care. This also indirectly impacts infection control because nurses are not involved in non-clinical work and Sodexo ensures that the attendants too are trained in infection control protocols.
Similarly, when it comes to biomedical care maintenance. Again, this is a very specialised job, where the equipment needs to be disinfected and managed well, whether it is clinical or non-clinical equipment like quality of air, service availability of HVACs, ater supply, etc. Both, if not managed well, will increase chances of HAIs.
This is again where technology comes in. Sodexo has a computerised maintenance management system. As opposed to being manually operated, this is a systems-driven process, whether it preventive or reactive maintenance. This ensures that we reduce breakdowns in the service availability of the equipment which will again reduce HAIs.
Winters: A lot of people don’t understand that most mistakes with medical equipment come from lack of training. We see Sodexo as a key to deliver the ongoing training, to both nurses and doctors in how to use equipment. It is amazing the value and volume of equipment that is no longer in service and put into storage in hospitals for no other reason than nobody knows how to use it properly. Incorrect use of equipment is where a lot of mistakes come in with consumer care too. This is the huge value proposition that Sodexo offers as a service provider to a range of equipment. We can provide the training and advice on how to use it to our customers and consumers.
As per the fiscal 2015 figures, which is before the re organisation took place, 41 per cent of Sodexo’s revenues came from North America, 31 per cent from Europe, 10 per cent from the UK and 18 per cent from the RoW. Is there any change in this geographical distribution? And in terms of activity-based revenues, on site services was 96 per cent, where healthcare accounted for 18 per cent. Any changes?
Winters: Healthcare still accounts for around 18-20 per cent of global revenues. We don’t measure our revenues by geographies any more. We segmented our businesses in 2015 so that we could have an absolute focus on our clients. So we created the healthcare senior segment, corporate, education, government and agencies, justice. So, we look at segment-wise global revenues. Sodexo’s healthcare business turnover globally accounts for under ¤ 5 billion per year.
How much of this Euro 5 billion turnover would be from Sodexo India’s healthcare business?
Sahu: The last five years, post segmentation in 2012, has been good for us in India. We’ve almost doubled our revenue, tripled our profits. The opportunity for the next 10 years is huge.
Winters: That’s true. The entire Asia Pacific region that I am responsible for has massive opportunities. South East Asia, India, China, has a growth potential. The adoption of new services will come at different rates and speeds. We’re on a journey and it has been very successful so far. We see a large adaptation of global services especially around CSSD, biomedical engineering, and environmental services with HAIs. We see a very high level of interest in these areas in the India market.
What is the focus for fiscal 2017? Would you expect the same growth rates for India going forward?
Sahu: We are not going to be satisfied with the growth rate of the last five years. We are going to double it. Especially because we are entering the new space of public health facilities. The opening up to (the idea of) outsourcing opens up a huge opportunity for us.
There is a lot of consolidation in the private healthcare space and they are looking for mature players like Sodexo where we can add a lot of value.
The balance sheets of a lot of corporate hospitals in India are showing some stress, partly because they have taken on debt to expand and also because its always difficult to grow on a high base. How does this impact your growth potential?
Sahu: I see this as an opportunity to drive efficiencies for all services.
Winters: I think growth will come naturally and organically because the market is so big, it is looking for the cost savings, international methodologies, standarisation of services. So we need to remain focussed on successful roll out and adaptation of services because that will bring growth automatically.
There are many new AIIMS coming up across the country. Are you involved with these new projects as well?
Sahu: We are in touch with multiple AIIMS. The solutions that they are looking for are at the design stage. Which is very good because if they don’t design the facility correctly then that could create future problems. HITES is in charge of building the infrastructure, which is why our association with HITES is so crucial key. We get involved at the designing stage and design it right.
Winters: We bring the whole life cycle costing opportunity to the table. Constructing a hospital is one only part of the cost. Having a 20 year vision, of what it costs to maintain, how a hospital should be set up, what material should be used, etc is also important. Year two to year 20 could be significantly more costly than building a hospital if you don’t get the design right. That’s where we see that we could play an integral part of the front end and through the journey of the life cycle.