Florence Nightingale was a key figure in the transformation of the Nursing profession. Before her hospitals were essentially run by religious institutions where people were cared for in their last days, essentially palliative in nature. During the heights of the Crimean war, Florence Nightingale with a lamp in hand started the beginning of what we call modern nursing care and established nurses as the corner stone of modern healthcare.

Today nursing in India is at another cross roads. While digital and technology have empowered patients to seek the best in care, nurses in India struggle daily against rising stress levels, lower pay and unending demands of the modern healthcare system. Attrition among nursing staff is around 40- 60%. And each day nurses migrate from India to countries like Canada, Australia, New Zealand and Ireland and Middle East.

In this challenging scenario there are healthcare leaders who are working with the system to improve working environments, undertake digital transformation initiatives and continue to improve standards of care.

So in this special and first of its kind interview, we look at an area never before covered under Healthcare India- Nursing services. We had the opportunity to talk to Lt Col (Retd) Binu Sharma, Senior VP Nursing Services at Columbia Asia Hospitals.

Col Sharma entered the nursing profession almost 40 years ago in 1977. She has been in charge of nursing at Columbia Asia since 2007. Today her organization has more than 2000 nurses and technicians in hospitals across the country. Below are some excerpts from the interview

Healthcare India: what is the state of digital transformation in the nursing profession? How involved are the nurses in areas like creating solutions under digital health initiatives?

Col Binu Sharma: Columbia Asia has the policy of ensuring nurses are key participants in the digital health initiatives. We have a proprietary Health Information System (HIS) called ‘CARE 21’. It was developed by the internal IT team at Columbia Asia. The nursing team was involved in most modules of the HIS, particularly the ones that concern with patient records, medicines, vital parameters, assessment of key clinical parameters etc. So today there are hardly any paper forms at Columbia Asia. The few paper formats you might get at the hospital are the consent form, a few checklists. Most patient related forms are in electronic format.

Today all patient related processes are done through HIS- registrations, admissions, out- patient and inpatient assessments & consults, inpatient transfers, progress notes and communications from ICU, Operating rooms and wards  are done through the system The system also connects all the diagnostic departments like Radiology & Pathology and even here all records are maintained digitally. There is a business intelligence portal that sits on top of the medical record, this helps the nurses pull out the dashboards including key KPI’s( key performance indicators) for performance.

Healthcare India: That’s great to hear. What types of investments were made in training and in change management for the nurses to get them up to speed with the new system?

Col Binu Sharma: We have invested significantly into change management and training of the nurses. In basic nursing procedures training we have installed the Wolters & Kluwer training content. These are considered gold standard for nursing across the world. Each nurse has her own id and password and she can take this self-paced training from any computer in the facility.  This also enables them to evaluate their knowledge. The nurses are assigned specific certifications based on their job scope. The report is available to reporting managers to assess competencies In order to enhance the usage of this learning platform, access is also given to nurses on their mobiles. Therefore it is not necessary for the nurses to be present in the hospital premises to get themselves trained. They can learn and enhance their knowledge as per their convenient time and place.

Columbia Asia also has developed specialty specific training modules for skill up – gradation in highly specialized areas and there is a well- defined annual training plan for nurses. These include many in digital formats like videos, animated presentations among others that are available to all the nurses. We have also developed and invested in technical training modules online for technicians in certain specialties. There is an excellent dialysis training module we have developed in collaboration with Bodhi Health. The module has got an excellent feedback and we in the process of developing more and more such modules.

In the future we plan to introduce online proficiency tests for nurses for recruitment and to measure the effectiveness of all trainings.

Healthcare India: But what about change management, especially as you migrate from paper to digital formats?

Col Binu Sharma: Yes that’s an important component of our strategy. Luckily for me I did not have the baggage of traditional thought as we built this new digital system for the nurses. When we started our hospitals in India in 2005, it was very clear that technology and digital platform would be the key to our efficiency. When we hired nurses, we were very clear that these nurses would have to use technology extensively. The ones who were fresh graduates were open to change and took to the new systems immediately. But retraining the senior ones is a challenge at times. They have the tendency to go back to paper formats.

So we dealt with the system in very interesting ways. We stopped allowing paper into the wards. That way the nurses had to use the system to enter in patient records, medication and other instructions form the doctors. This ensured that those hired laterally came up to speed very quickly. Today nurses have the option of using PCs and Computers on Wheels at the bedside. We are considering use of tablets and smart phones for usage at bedside for quick and real time entry of vital parameters

In addition when we open a new hospital, 45 days before the launch we have hands on training for all staff. This includes the nurses and they have enough time to familiarize with the HIS and digital platforms. This way across Columbia Asia all nurses are very competent on digital technologies.

Healthcare India: Across the country I hear that attrition is a major challenge. How are you dealing with that?

Col Binu Sharma: I think the Nursing profession is at a revolutionary phase in the country. There is huge demand and there are not enough nurses to meet the demand. To begin with many young people don’t choose nursing anymore. They prefer courses like engineering, medicine and management. So there is a big gap. Secondly it is not considered prestigious to become a nurse in our country. The salary is not good enough to attract young generation to choose this profession. The job is highly challenging but without much recognition. Nurses spend a sizable fee to study in private colleges

In addition to this there is a lot of demand from overseas. Most nurses’ head out to overseas countries like Canada, Australia, New Zealand, Ireland and many others  as the pay and working conditions are much better there. Then there is always a huge demand for nurses in Middle-East, which still attracts a lot of nurses. The remaining nurses prefer government jobs as the pay is steady, there are benefits on retirement and they are eligible for health insurance under government schemes. The private sector is the last option hence we are not able to attract the best talent.

In order to make Columbia Asia a very attractive option for nurses we have taken the following steps

• We ensure that we carry out salary surveys every year and make market corrections accordingly
• Provision of good, safe living hostels for the nurses
• Transportation to and from the hospital and  nearest drops specially in case of late shifts
• Nurses are treated at par with the doctors and the other staff at the hospitals
• We invest in their training as discussed earlier
• Flexible shifts, part time options and encourage them to leave on time after work
• They are encouraged to participate in games, cultural events and fun activities to reduce stress

Despite all this there is attrition and we lose them to overseas jobs, government jobs and at times to competition hospitals .It is interesting to mention here that we also have a huge number of nurses joining us back after they had left us as many of them expressed they missed Columbia Asia Culture there!

In order to improve the conditions, I have been actively involved with nursing associations and nursing advisory boards to make recommendations for Nursing Reforms in the country. One such group is led by FICCI and together with a group of Nursing and other industry leaders. We have submitted a white paper with 30 recommendations for the better working conditions, salaries, education reforms and other areas of improvement for the nurses

Healthcare India: That is really encouraging and in due course we would like to know more about the nursing advisory board. In the meantime how are things changing with the increase in Home Healthcare?

Col Binu Sharma: At Columbia Asia we have not directly entered the home healthcare space. We partner with organizations like Nightingales, Portea and Healthcare at Home. Home health is shaping up well in the country right from remote monitoring, to acute and chronic care being managed at home in a defined structure and that is a future need due to increasing life span in the country. Also for many families, home health care is a beneficial choice—a safe and affordable solution that supports the family, while allowing your loved ones to stay in the comfort of their own homes and communities.

Thank you Col Binu Sharma for talking to us. Looking forward to more insights from you on the state of healthcare in India and role of nursing in the same.