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A Reflection on a Decade of
Partnership and Collaboration
Wockhardt Hospital/Partners
HealthCare International
Table of contents
I.Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
II. From bench to bedside: The WHL journey into clinical care. . . . . . . . . . . . . 4
III. The partnership: A collaborative model. . . . . . . . . . . . . . . . . . . . . . 5
IV. Key takeaways: Program and impact . . . . . . . . . . . . . . . . . . . . . . . 6
Action 1: Invest in human resources. . . . . . . . . . . . . . . . . . . . . . . 7
Action 2: Create a culture of learning and growing . . . . . . . . . . . . . . . . 8
Action 3: Recognize and reward excellence. . . . . . . . . . . . . . . . . . . . 9
Action 4: Develop a high performing care delivery structure for peak potential . . . 10
V. Conclusion: Raising the bar for health care in India . . . . . . . . . . . . . . . . 11
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I.Introduction
Wockhardt Hospitals, Ltd., based in Mumbai, India owns
and operates a network of leading subspecialty hospitals
in India. Partners HealthCare International (PHI) draws upon
the experience and resources of Partners HealthCare to
collaborate with international colleagues to improve health
care worldwide. The two organizations have worked together
for over ten years developing an integrated care system
to serve expanding patient needs in India. Many of the
improvements they have brought about are now considered
best practice in India’s challenging and competitive health
care environment. What sets them apart, however, is a
remarkably aligned leadership style and corporate culture
based on empowering staff – at all levels of the organization – to
participate in, and lead, improvement efforts. Through tools and
training, the entire Wockhardt organization has been mobilized
to adapt new behaviors and make change happen – from the
ground up. To mark the tenth anniversary of the relationship,
the teams took a retrospective look at the key leadership
principles that were the cornerstones to their success. This
is a report on a decade-long collaborative effort between
Wockhardt Hospitals, Ltd, and PHI to achieve excellence by
identifying and solving systems problems at the point of
patient care. The results of four initiatives are presented along
with evidence for their impact and implications for Indian
health care.
The predominantly tribal district of Jhabua is the site of an education program
aimed at providing nurses, midwives, teachers, and community leaders with
the tools and knowledge to address the HIV/AIDS problem in the region.
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II. From bench to bedside: The WHL journey into clinical care
Wockhardt Limited is one of India’s top research-based
pharmaceutical and biotechnology companies. Its Chairman
and Managing Director, Habil Khorakiwala, built the company
from its roots in Mumbai to a billion dollar global enterprise. For
most entrepreneurs, growing a business across 14 countries
in five continents would be a lifetime’s achievement, but as a
pharmacist, Mr. Khorakiwala wanted to put a human touch to
what he had always understood at the molecular level – that
focused, high-quality patient care was important. With this in
mind, he was certain he could build a better hospital and raise
the health care benchmark for the people of India.
With an aggressive growth strategy and a commitment to do
things differently, Mr. Khorakiwala was destined to take the
Indian health sector to new horizons. He envisioned a “hub
and spoke” model, in which clustered health care organizations
would focus on tertiary and quaternary care, and link to larger
surrounding geographic regions, where secondary and
primary care are delivered. He thought this model would rely
on sending patients from the lower acuity outpatient settings
to the larger, more comprehensive tertiary care center. He knew
there would be more risk for care across the continuum, but
Wockhardt’s Performance Improvement Plan has served as a model across
India, encouraging quality and performance improvement initiatives in
all aspects of health care.
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believed strongly in providing expanded services in a lower
cost, higher quality and more efficient manner. It was with
this vision, that Wockhardt became one of the first corporate
health care chains in India.
In 1990, Wockhardt Hospitals, Ltd (WHL) opened a medical
center in Kolkata and its first hospital in 1991 in Bangalore.
In 2002, Wockhardt Hospital in Mulund, Mumbai opened,
followed two years later with the Wockhardt Heart Hospital in
Nagpur. It wasn’t long before they established a reputation for
excellence in tertiary care, with specialized fields in cardiology
and neurology. However, as its multispecialty network began to
take shape, WHL found itself at an interesting juncture – facing
both the momentum and significant risks entailed in the health
care business sector. Dramatic changes in technology, patient
safety issues, staffing challenges, and a dynamic marketplace
were just a few of the complexities WHL faced. At the same time,
however, WHL recognized that these driving forces presented
opportunities, and to capture them, they needed to build
specific capabilities, develop new integrated programs, and
learn from global institutions that have faced similar challenges
and initiated innovative ways of providing quality health care.
III. The partnership: A collaborative model
In 2001, WHL reached out to Harvard Medical International, now
Partners HealthCare International (PHI), to collaborate with the
largest integrated, academic health care system in the United
States – Partners HealthCare System (PHS). The goal of the
partnership was to develop training and education programs to
support organizational development and quality improvement
throughout the growing Wockhardt Hospital network.
Simply deciding to join forces and share knowledge with
PHS, however, was no guarantee of success for WHL. To be
successful, Mr. Khorakiwala knew that the project had to
begin with the right relationship. He wanted a dedicated
partner who would work shoulder to shoulder with his team
through planning and implementation, resulting in action and
accountability. He subsequently decided that PHI was the right
fit with their unique collaborative model of partnership. It was
from this early beginning, that the WHL/PHI relationship was
founded on a mutual commitment and shared expectations
as well as the responsibility for local WHL capacity building.
It turned out to be a mutually cooperative relationship, where
each organization helped the other, even through times of
transition and uncertainty. To navigate the ups and downs,
WHL and PHI developed a supportive partnership. Elizabeth
Brown, PHI’s Director of Global Nursing Programs reflected,
“This was not a simple client-provider relationship, but a more
co-operative partnership in which both organizations went
beyond professional obligations.” She went on to add, “our
relationship was a two way street: they learned from us and
us from them. Their successes were our successes. Similarly,
their disappointments were also our disappointments.” These
interactions helped to breed familiarity between the teams
and developed emotional ties to the relationship.
According to Dr. Mehul Mehta, PHI Vice President and longtime PHI/WHL executive, “the teams shared a genuine
friendship built on respect.” However, there are always difficult
conversations in any business relationship, as Dr. Mehta
explained, “The difficult conversations were never personally
difficult or seen as conflict. They were a dialogue for trusted
and loyal colleagues to understand the issues facing the
organization and constructively find solutions.” As a result, trust
became the main governance mechanism for the relationship.
The relationship between PHI and WHL that was based on trust and mutual respect, allowed the quality improvement
process to move forward successfully since 2003. As a result, in a relatively short period of time, WHL has become a leader in
Indian health care quality and patient safety.”
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IV. Key takeaways: Programs and impact
Building a solid relationship and working toward shared goals,
however, explains only part of the collaboration’s strategies.
While the organizations were unwavering in their mutual
commitment, the collaboration has also remained true to its
principles. In India there is a proverb, “Nothing grows under
a banyan tree.” It compares leadership styles to a spreading
banyan tree, sometimes covering an acre of land. Birds, animals,
and humans find shelter in its shade, however, nothing can grow
under its dense foliage. In contrast, WHL and PHI supported an
environment that allowed others to flourish and grow from the
ground up.
To that end, four crucial leadership actions have emerged as
critical the collaboration’s success:
1)invest in human resources;
2)create a culture of learning and growing;
3)recognize and reward excellence; and
4)develop a high-performing care delivery structure surrounding
staff so they and the institution can reach their peak potential.
The case studies below present an account of what happened
when these principles were embraced by the collaboration.
Implications for Indian health care are also discussed.
Nurses from throughout the Wockhardt network exchanged insight into day-to-day
leadership and management challenges during the first nursing leadership workshop
that became the starting point for a major nursing initiative.
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Action 1: Invest in human resources
Developing educational programs that make an impact on HIV/AIDS
The problem
In 2001, the incidence of HIV and AIDS was rising in Asia. Some
experts estimated that India would have the highest infection
rate by 2010.
The challenge
Despite a commitment from the country’s health care
leadership to stem the epidemic, the challenge remained to
build the capacity of medical providers to prevent, diagnose,
and treat HIV-related conditions and educate patients about
the disease.
The goal
As one of India’s leading health care establishments, WHL was
positioned to train providers and empower them to control
the HIV/AIDS epidemic in resource-limited areas throughout
India.
The program efforts
Wockhardt and PHI formed a nongovernmental organization
called Wockhardt-Harvard Medical International AIDS
Education and Research Foundation (WHARF), now simply
Wockhardt HIV/AIDS Research Foundation. Funded in part by a
grant from the Horace Goldsmith Foundation, WHARF offered
a series of monthly educational programs targeted at health
care providers working with HIV/AIDS in their communities.
The key features
• Program faculty included local experts as well as faculty
from Harvard-affiliated hospitals.
• Symposia and training sessions focused on the science and
epidemiology of HIV-related disease, counseling and testing,
antiretroviral therapy, primary care for HIV-positive patients,
prevention of mother-to-child transmission, mental health
aspects of HIV/AIDS, and the health professional’s role in
prevention.
The impact
Since its inception, WHARF has worked with dozens
of organizations in Mumbai, including hospitals and
governmental agencies. The organization is recognized
nationally as a catalyst for similar collaborations between
health care providers and NGOs working in the region.
• Thousands of care providers received training at WHARForganized programs.
• Trainees have gone forward to train thousands more
maximizing the impact on communities.
• WHARF has implemented guidelines, targeted high-risk
communities and served as an effective vehicle for the
dissemination of new prevention and treatment guidelines.
• WHARF programs have fostered the development of a core
group of educators and leaders committed to advancing
HIV/AIDS care and education in India.
• The program is now implemented and delivered solely
by WHL and local faculty experts, taking on a new name,
Wockhardt HIV/AIDS Research Foundation.
• WHARF programs continue to grow and evolve; now
directly impacting children and families living with HIV/AIDS
by providing nutritional support.
Implications for Indian health care
WHARF created an environment that encourages people to
be open about risk, compels them to learn about their HIV
status, and makes resources available for prevention and
treatment. Its collaborative model of working with likeminded
institutions in India and abroad magnified efforts and sent a
consistent message fighting HIV/AIDS stigma throughout the
region. Today, WHARF is recognized as the catalyst for other
collaborations between health care providers and NGOs
working on HIV prevention and treatment throughout the
country.
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Action 2: Create a culture of learning and growing
Building the capacity of health care professionals and hospital leaders
The problem
In 2006, geographical expansion, new hospital development,
and the implementation of new clinical programs and
technology were taking WHL into new territory. To sustain a
high-performing delivery system in this complex environment,
WHL needed quality improvement, patient safety and hospital
accreditation.
The challenge
WHL recognized that an integral driver of these efforts
would be a premier and comprehensive nursing service and
a strong nursing leadership team. Leadership welcomed
the opportunity to strengthen the educational and career
development needs of its nursing staff.
The goal
To develop a core group of nurse leaders to drive quality
improvement efforts, nursing leadership training, and nursing
education initiatives across the Wockhardt health care system.
The program efforts
Teams in India and Boston strategized to create curricula to
support an integrative nurse leadership model and certificate
program customized to the local environment and WHL’s
specific institutions. Recognizing the managerial dimensions
of nursing, they designed an innovative four-part leadership
development program that would focus on managing the
performance of the patient care environment, leading people,
and managing the business of health care. The program also
wove in a sustainability component with a train the trainer
program for future faculty.
The key features
• A team of faculty colleagues representing nursing,
human resources, organizational development, quality
management and project management.
• Intensive 18-month nurse leadership competency
development program with four week-long sessions codirected by PHI faculty and members of the Wockhardt team.
• Leadership projects to work on over the year to improve
individual leadership capacity and unit based performance.
The impact
The Nurse Leadership Program at Wockhardt is in its seventh
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year. As planned, it is now implemented and delivered by WHL
faculty with phone and email consultations with Partners
International as required.
• National and international recognition.
• Increased staff retention and patient satisfaction.
• Improved nursing-sensitive indicators (pain management,
ventilator associated pneumonia, decreased falls, decreased
thrombosis).
• Increased hand hygiene and more appropriate use of gloves.
• Improved efficiency and decreased discharge times across
multiple units.
• Trained teams of faculty to deliver curriculum across the
system.
• Improved succession planning and development of future
leaders.
• Abstracts accepted and presented at international quality
and safety conferences.
• Stronger inter-professional teams working side-by-side
on clinical program planning, quality improvement, and
departmental multidisciplinary education and care delivery.
• Shared governance model with staff nurse committees
across WHL system in quality, nursing practice, and nursing
education.
Implications for Indian health care
WHL’s nursing workforce is well-versed in and passionate
about nurse leadership. They are important cultural change
agents for the region leading to substantial improvements in
quality, patient safety, patient outcomes and fiscal health. This
development of the nursing profession represents the most
significant opportunity for improving health care delivery in
India.
Action 3: Recognize and reward excellence
Honoring pioneers in Indian medical services
The problem
The new millennium greeted India with daunting health
challenges. Maternal and infant mortality rates were high.
Malaria and tuberculosis persevered. Diseases such as diabetes
and cancer were increasing. And many, especially the poor,
lacked good and affordable health care. Some Indian physicians
devoted their whole lives to make advances around these issues.
Nonetheless, their relentless dedication, commitment, innovation
and excellence in medical services went unrecognized.
The challenge
Excellence in medical services had never been formally
acknowledged in India. WHL believed, however, that
meaningful recognition and reward was necessary so that
outstanding clinicians were valued and rewarded to continue
their commitment to the public’s health.
The goal
To establish a first-of-its-kind lifetime awards program to
reward Indian medical leaders who helped make significant
advances in medical research, prevention, diagnosis, and
specialty care in India.
The program efforts
Every other year from 2003 to 2009, PHI and WHL honored a
select group of Indian physicians whose leadership has left
a lasting imprint on health care in India. The awardees were
chosen for their achievements in the areas of patient care,
teaching, institution-building, leadership in medical and public
health organizations, research, developing new and innovative
institutions and the impact of their work on public policy for
the good of the country.
The key features
• Candidates were nominated by their peers in India based
on a criteria set organized by an independent PHI Awards
Selection Committee comprised of senior consultants from
Partners HealthCare, Harvard Medical School (HMS) and
Indian leaders from the chosen professions.
• The top five nominees for each category were recognized
and presented with the Award Certificate during a ceremony
in India by members of the Indian medical community as
well as senior faculty from PHI and the Awards Selection
Committee.
• The ceremony featured two guest speakers from the faculty
of Harvard Medical School, including Joseph Murray, MD,
professor emeritus of surgery, who was awarded the Nobel
Prize after performing the first kidney transplant in 1954.
• The winners of the Wockhardt Medical Excellence Awards
visited Boston, where they spent time in Harvard Medical
School-affiliated hospitals and attended lectures and
discussions facilitated by PHI with top health care leaders in
the Boston medical community.
The impact
Twenty Indian physicians were recognized for bringing
advances in medicine to India and leading community
outreach efforts to increase high-quality health care for
underserved populations.
• Engaged Indian and Boston-based health care leaders in
a discussion to understand what is needed to address the
health challenges in India.
• Provided a bridge between innovations in India and
in Boston as physicians exchanged ideas and gained
experience.
• Enhanced awareness of health challenges and advances in
India.
• Promoted the importance of physician service to the
underserved, reinforcing the role of service to improve
public health.
• Received national recognition.
Implications for Indian health care
The Awards program was the first of its kind in India to support
excellence in clinical medicine and public health. A major
criterion for selection was public health and outreach to a
large number of patients. The inspirational stories of awardees
demonstrated the enormous impact that one person can
have in his or her community. This has brought attention to
and changed the perception of the role of service for the
improvement of public health in India. The program has
also prompted the development of meaningful recognition
programs throughout India’s health care community for those
achieving excellence.
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Action 4: Develop a high performing care delivery structure for peak potential
Enhancing programs using international benchmarks of quality and effectiveness
The challenge
In 2003, health care organizations around the world were
striving to improve the quality of care they delivered. The
Indian health care industry in particular was undergoing
transformation, marked by increased competition, a high level
of customer awareness of the quality of hospital services, a
heightened focus on quality and performance improvement,
and the rapid growth of the private health care sector. To
be successful in this environment, health care organizations
needed to Improve quality of patient care to meet international
standards.
The goal
To develop and implement an infrastructure including clinical
and administrative protocols to support quality management
and performance improvement while creating an environment
focused on quality, safety and continuous improvement that
could be replicable across the WHL network.
The program efforts
In 2003, PHI and Wockhardt began a collaboration aimed
at instituting a sustainable quality improvement model for
Wockhardt Hospitals in Mulund (Mumbai), which had opened
a year before. The teams worked together to:
• Develop a Performance Improvement Plan with clear
benchmarks and measures to guide continuous
improvement.
• Create a multidisciplinary Care and Quality Improvement
Council made up of representatives from around the
hospital to oversee aspects of the plan’s implementation.
• Align Wockhardt’s efforts with the defined standards related
to different aspects of quality and patient care, such as
infection control, health information management, patient
safety, and clinical quality performance indicators.
• Collect input from all facets of the medical and administrative
staff to encourage the development of a quality culture.
• Provide professional development and training for medical
and administrative staff.
• Establish the processes and specific outcome measures for
patient care and self-assessment.
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The impact
Wockhardt Hospital Mumbai made considerable strides
implementing its new health care quality improvement
program. In 2005, just two years after its opening, the hospital
received accreditation from JCI, only the second health care
provider in India to earn this distinction. The efforts leading
to this achievement served as the model for performance
improvements at Wockhardt’s other hospitals, including
facilities in Bangalore, which won accreditation in 2008.
• A “culture of quality” that is part of the Wockhardt fabric
across the network.
• Higher quality of patient care and service at WHL hospitals.
• Greater accountability and better trained health professionals
as staff take on active roles in the hospital’s progress.
• Access to a variety of resources that connect WHL with the
international health care community.
• Outcomes of quality improvement initiatives have been
highlighted at major health care industry conferences and
publications.
• Foster open dialog across disciplines and professions about
how to drive improvements.
• Up to date standards and systems for organizational
excellence, quality and safety.
Implications for Indian health care
Wockhardt’s performance improvement plan has served as a
model across India. Its structured problem solving approach
provides an objective and systematic method of enhancing
quality in health care institutions, encouraging quality and
performance improvement initiatives in all aspects of the
health care. A focus on quality is seen as a key to enhancing
the safety and quality of health care in India.
V. Conclusion: Raising the bar for health care in India
Since 2001, PHI and WHL have worked to transform WHL –
already a leading health care network in India – into a highperforming delivery system offering international-standard
clinical services.
An emphasis on identifying, investing in and nurturing
champions has been critical to the collaboration’s
effectiveness. During the decade, the collaboration invested
extraordinary resources in developing best practice
approaches, education programs, and quality improvement.
With these tools and training, WHL frontline health care teams
redesigned the processes of care from the ground up. As
programs were implemented successfully and evidence of
improved care was documented, the approach was widely
embraced organization-wide. Many of the improvements they
introduced at WHL are now considered critical to the success
of health care in India and whose direction the collaboration
was able to affect.
Today, WHL has its presence across India with eight multispecialty hospital networks. Mr. Khorakiwala’s daughter,
Zahabiya, oversees the health care arm of WHL and is
expanding the Wockhardt hospital chain to smaller towns. The
first health care group to enter the tier II Indian towns, WHL now
has a presence in the Gujarat, Nagpur, Nashik, Goa and Vashi
with a total of 1,200 beds under its management. The ninth
WHL hospital will open in November 2014 with a 22-storeyed,
350-bed, super-specialty hospital in South Mumbai. It will have
the largest number of beds among the Wockhardt hospitals.
With these exciting new developments on the horizon, the
PHI/WHL relationship was renewed for another five years.
These long-time friends and collaborators will continue to play
a significant role in the health care transformation in India.
Through tools and training, the entire Wockhardt organization was mobilized to adapt
new behaviors and make change happen – from the ground up.
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Partners HealthCare International® (PHI) is the global division of Partners HealthCare, one of the leading
United States health systems located in Boston, MA. Partners HealthCare is one of the largest not-forprofit, academic health care systems in the United States. Our founding hospital members, Massachusetts
General Hospital (MGH – ranked #1) and Brigham and Women’s Hospital (BWH – ranked #6), are the only
two hospitals in one city ranked in the Top Ten by US News & World Report. MGH and BWH are the largest
and oldest teaching hospitals of Harvard Medical School, and our physicians constitute the majority of
Harvard Medical School faculty. Learn more at www.partners.org/international.