Narayana Health


“Most of the things worth doing in the world had been declared impossible before they were done.”1– Louis D. Brandeis

Background

Narayana Health (NH) is a large Indian hospital chain. It was established by Padma BhushanDr. Devi Prasad Shetty in 2001, with the objective of providing affordable cardiac care to the masses. 

NH presently comprises a network of 25 hospitals, 7 heart centres and 19 primary care facilities spread across 31 Indian towns and cities. It has over 5,800 operational beds. Over2 million patients from all parts of India and across the world avail of its facilities every year. As of December 2017, NH had 15,906 full-time employees and associates – including 3388 doctors. 2

In FY 2018, NH clocked revenues of Rs. 2,280 crores. The earnings before interest, taxes, depreciation, and amortization (EBITDA) stood at around 10 %.Around half of its inpatient revenue is derived from cardiology and cardiac surgery. However, NH provides advanced levels of care in over 30 medical specialties that include oncology, neurology, orthopedics, ophthalmology, and gastroenterology. 

Cardiovascular disease is one of the biggest causes of deaths in India. The Indian subcontinent accounts for 45 % of coronary artery disease worldwide. The country requires 2 million heart surgeries annually, as against the 125,000 that are currently performed by all of the hospitals in India put together. The remaining patients simply perish.

The mission of Narayana Health is to provide affordable medical care to the masses. The institution seeks to become the lowest-cost, high-quality healthcare service provider in the world.

To fulfill this mandate, NH has developed a scalableeconomic model. The costs have been brought down substantially through process innovation, low equipment rentals, more operations per doctor, and reduced hospital set-up costs.Specialization and economies of scale are also leveraged extensively. 

Attracted by its reputation for high quality, the affluent patients come to NH for superior medical treatment. The surplus gained from treating these patients subsidizes the procedures that are performed for the economically needy patients.

NH has devoted much energy and attention towards boosting its customer base. This has been largely for humanitarian reasons, but also because it believes that higher volumes lead to better quality and lower costs. NH worked with the Karnataka state government and various local co-operative societies to help create a health-insurance scheme that covers over 30 lakh people for a nominal premium of around Rs. 18 per month. The institution has also established video and Internet links with other hospitals in India, Africa and Malaysia, so that its surgeons can give expert advice to less experienced colleagues. NH hospitals also send out “Clinics on Wheels” every week to nearby rural areas, in order to screen the local people for heart disease. 

NH does not own all the hospitals and other facilities that it operates. Some of its facilities have been acquired on lease. In other cases, the hospital premises are owned by another party but operated by NH on a revenue-sharing basis. For some hospitals, NH simply provides management services to a third party for a fee. This calibrated approach has allowed NH to achieve an effective capital cost of Rs. 28 lakhs per bed, which is far less than the current norm.

NH presently charges an all-inclusive fee of about US$ 2000 for heart surgery. The package covers all the expenses, from the point of admission to the time of discharge. This is a fraction of the price charged by the other Indian hospitals, and miniscule as compared to the fees prevalent in the western world. 

Yet, the institution is taking several measures to bring down the cost further. It maintains a very tight control on its purchases. The prices are also driven down through direct negotiations with the equipment manufacturers. NH also encourages domestic companies to manufacture inexpensive local versions of costly imported medical supplies within the country. 

The organization is building low-cost, single-floor hospital buildings – especially in the Tier 3 cities of India. Air conditioning at these locations is provided only in the Intensive Care Units and the Operation Theatres; cross ventilation is used to cool all the other areas. 

Through its Care Companion program, NH trains family members in performing simple yet time-consuming tasks related to the provision of post-operative patient care at home. This simultaneous focus on cost, quality and compassionate service has been the primary driver of success for NH. 

The NH Chairperson Dr. Devi Shetty is a compassionate human being, an excellent pediatric heart surgeon and an astute businessperson – all rolled into one. He is India’s first neonatal open-heart surgeon. In a career that has seen him perform over 16,000 operations, Dr. Shetty has also been dubbed as the “Henry Ford” of heart surgery. His medical teams move from one operating table to the next in a very precise, assembly-line style. 

Dr. Shetty seeks to make quality health care affordable for the masses, while simultaneously enabling the venture to stay profitable. When NH creates a surplus, it is able to attract good doctors and invest in world-class infrastructure. Both of these are necessary for attracting and serving an increasing number of patients in a sustainable manner. In turn, the high patient volume helps to bring down the treatment costs. It also helps to generate funds for the institution.

NH tapped the stock market in January 2016 through an Initial Public Offer (IPO). Following this, the Shetty family’s ownership of the company has been reduced to 62 %. However, Dr. Shetty dismisses the inevitable post-IPO pressure on quarterly growth. Reiterating that NH will continue to accord top priority to the welfare of its patients, he points out that the NH business model was never about free treatment but rather about affordable healthcare. 

Over its 17 years of existence, Narayana Healthhas been widely acknowledged for its selfless philanthropy in delivering much-needed cardiac care to the people of India at subsidized rates. This has brought smiles to millions of people with limited resources. It has also provided reasonable returns on the capital deployed by NH’s investors. 

Most importantly, NH has established a viable model of disruptive innovation in healthcare for others around the world to emulate.

The Genesis of the Institution

Dr. Devi Prasad Shetty was born at the Kinnigolivillage in the Dakshina Kannada district of Karnataka in 1953. He was the eighth of nine children in a family that revered doctors. 

In the fifth grade at school, the young boy heard from his teacher about Dr. Christiaan Barnard – the South African surgeon who had performed the world’s first heart transplant. He was deeply inspired, and instantly resolved to become a cardiac surgeon when he grew up.

Dr. Shetty completed his undergraduate medical degree and post-graduate work in General Surgery at the Kasturba Medical College, Mangalore. The seeds of his sensitivity to health care costs were sown in this preliminary phase of his career. 

Medical students in India are usually educated at “teaching” hospitals that are frequented mainly by large numbers of poor people. The young intern’s interactions with patients taught him much about the grim economic situation of rural India, and how that adversely affected the health of the people.

Dr. Shetty went for further training in cardiac surgery at Guy’s Hospital in London. This was one of Europe’s top medical facilities. He returned to India in 1989 at the invitation of the Birla family, in order to take charge of the newly established B.M. Birla Heart Research Centre in Kolkata. 

Dr. Devi Shetty rose to fame when he successfully performed the country’s first neonatal heart surgery on a 9-day-old baby in 1992. His reputation spread quickly. Patients began to throng to his heart clinic for consultations. However, very few of them returned for heart surgery because of the astronomical price tag attached to the procedure.

Sometime later, Dr. Shetty operated upon Mother Teresa when she suffered a heart attack. Subsequently, he served as her personal physician. Meeting Mother Teresa was like an encounter with the divine. It set the direction for Dr. Shetty’s aspirations in the field of healthcare.

His interactions with the famed humanitarian not only allowed for the close observation of her charitable work, but also caused Dr. Shetty to ponder upon how quality health care may be made affordable and widely accessible. “Hands that serve are more sacred than the lips that pray” were the words of the Nobel Laureate that had a profound effect on the young doctor. 

Upon reflection, Dr. Shetty came to the conclusion that the medical fraternity needed to redesign its processes. Instead of a magic pill, a faster scanner or a newer procedure, he surmised that the healthcare industry was required to reinvent its very methods in order that medical care may become available more cheaply and widely.

In the nineties, Dr. Shetty and his erstwhile colleague Dr. Alok Roy established the non-profit Asia Heart Foundation (AHF) at Kolkata. The AHF assisted in the commissioning of the Manipal Heart Foundation at Bangalore in 1997. It also established the 150-bed Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS) at Kolkata in the year 2000.

In 2001, Narayana Hrudayalaya (NH) came into being under the AHF umbrella – with the aid of a generous contribution by Dr. Shetty’s father-in-law. The latter’s firm Shankaranarayana Constructions built NH’s original two-storey hospital building that was situated upon 25 acres of land on the outskirts of Bangalore. It housed five Operation Theatres and 280 beds.3

At this juncture, Dr. Shetty and Dr. Roy parted ways on account of some mutual differences. Nevertheless, NH progressed and soon began to attract patients from around the world.

The Growth of the Enterprise

During the first three years, NH employed internally generated funds in order to expand into a six-storey building. It accommodated 500 hospital beds that were serviced by a team of around 90 highly experienced and reputed cardiac surgeons and cardiologists. This allowed the institution to handle complex and high-intensity clinical cases. 

Patients from across the Indian sub-continent as well as parts of Africa thronged to NH. This helped the organization to gain critical mass, and then expand rapidly by deploying external capital. 

Over a period of 17 years, NH has developed an extensive network of health-care facilities across India in order to serve patients from more than 50 countries around the world. It also ventured abroad to establish a 140-bed hospital in the Cayman Islands, just across from the United States. 

All the NH hospitals are fitted with modern medical equipment, follow well-defined safety protocols, and adhere to internationally accepted clinical standards of patient handling and care. 14 of them are also accredited with India’s National Accreditation Board for Hospitals and Healthcare Providers. 4

Around 12% of all the cardiac surgeries done in India are performed at NH hospitals. The pediatric intensive therapy unit at NH is one of the largest in the world. The mortality rates within 30 days of coronary bypass graft surgery (1.27 percent) and infection rate (1 percent) at NH are as good as that at hospitals in the United States. Further, the incidence of bedsores after a cardiac surgery (that globally ranges between 8 and 40 %) is virtually non-existent at NH. 

Over the last five years, NH has maintained a robust annual revenue growth of about 25%. Its reputation for clinical excellence, competitive salaries, and ethical practices have enabled NH to attract quality doctors and medical support staff within India as well as from among the returning NRI (non-resident Indian) medico fraternity. 

The YeshasviniHealth Insurance Scheme

In its endeavour to provide dignified and state-of-the-art healthcare to the billion-plus people of India, NH conceptualized the Yeshasvinihealth insurance scheme in 2003 with the help of the Karnataka state government. The 3-million strong membership of this micro-insurance scheme is drawn from among the small farmers who have been members of a co-operative society for at least one year. 

Every Yeshasvinimember pays around Rs. 18 as the monthly premium. The money so collected is used to fund the surgical and other treatment provided to the subscribers at around 400 hospitals across the state.

The idea of this micro-insurance scheme occurred to Dr. Shetty when he was approached by a milk co-operative society for the endorsement of its product. Upon learning more about the membership of the co-operative, it occurred to him that this would be the ideal opportunity for NH to access a clustered and organized group of middle-to-low income people with poor access to health care. 

Armed with this vision, the NH team conceptualized the Yeshasvinischeme for the farmers of Karnataka and their families. Its research estimated that only 0.08% of the policyholders would require surgical procedures in any given year. The rest of the members may need outpatient services, which are relatively inexpensive. 

The scheme covers a list of 1,700 human ailments that include the kind of health problems that villagers most commonly suffer from. It covers 805 surgical procedures, including those for the brain, heart, stomach, gall bladder and the kidneys. Consultations are free, while the diagnostic services are provided at discounted rates.

Prior to the formulation of Yeshasvini, the average occupancy of hospitals in Karnataka was estimated to be only 35%. Although the state boasted of 30 private medical colleges with a 500-bed hospital attached to each one, the actual occupancy was quite low due to the high treatment cost. 

In the scheme’s first year of operations, 35,000 farmers received outpatient treatment and 9,000 people underwent various surgical operations. The good reputation of NH helped to garner support for the program among the farmers as well as the hospitals. The hitherto under-utilized hospitals also reaped the benefits of participating in a trustworthy scheme that increased their patient flow.

The Telemedicine Network

Another major enabler for the institution’s ambition to provide cardiac care to the rural poor was the use of telemedicine. In order to reach out to the patients in the remote Indian rural areas, NH collaborated with the Indian Space Research Organization (ISRO) to build a network of 39 telemedicine centers that offer services to the local people free of charge. 

Cardiac specialists are rare in remote areas. Thus, heart attack victims usually turn to general practitioners (GPs) who sometimes prescribe incorrect treatment due to a lack of knowledge and/or facilities to correctly diagnose the problem. 5

Sensing the need for immediate treatment and care in rural areas, NH set up nine coronary care units (CCUs) across India. Each CCU was linked to an NH hospital, and was equipped with beds, medication, computers, electrocardiogram (ECG) machines, video conferencing facilities, and the technical staff trained to operate the equipment. 6

When a patient visits a CCU, his or her ECG is transmitted to a specialist at an NH hospital. With the patient and the local physician on the screen, the specialist diagnoses the condition and advises upon the appropriate treatment. Patients who need to be kept under observation stay overnight at the CCUs, while the NH specialists conduct daily virtual checks on their condition. In serious cases, the patient is transferred to the nearest NH hospital for subsidized surgery. 

NH also commissioned a special software program that allowed ECG images to be scanned and transmitted via an Internet connection. In very remote areas where video conferencing facilities could not be set up, a network of around 100 family physicians could still manage to use the software for transmitting ECG images to the NH hospital for diagnosis. 7

The cost of setting up the CCUs was funded by the AHF, as were the staff salaries and operational costs. The Indian Space Research Organization (ISRO) adopted telemedicine as a community project, and thus offered its connectivity infrastructure free of charge. ISRO’s technology allowed the network to operate through a satellite connection that provided clearer images as compared to the more expensive (and less reliable) telephone lines. 

The telemedicine network has now expanded to cover 332 hospitals – 299 remote/rural/district hospitals and health centres as well as 33 hospitals across the major cities of India. In fact, this service has now evolved to connect NH hospitals with patients even in Mauritius, Malaysia, Pakistan, Bangladesh and sub-Saharan Africa. More than 50,000 patients have been treated through this mode over the span of a decade. Telemedicine has provided ordinary doctors in far-flung areas the opportunity to save lives and accomplish extraordinary results.

The Humanitarian Mission

In order to sustain its humanitarian mission, NH has treated a mix of paying and non-paying patients from the very first day. It offers semi-private and private rooms for those who can afford better personal amenities. For those who can’t afford the hospital’s regular charges, and are also not a part of the insurance plan, NH offers concessional rates that are a function of the patient’s financial capacity. The subsidy is funded either by the NH Charitable Trust or by individual and institutional donors. However, the medical facilities are the same for every patient. 

NH also organizes outreach camps for cardiac diagnosis and care. Every weekend, buses are sent out to the rural areas around its main hospitals. Each bus is staffed with at least three doctors, including an experienced cardiologist and two trained technicians. Besides their own power generator, these buses are fitted with ECG, echocardiography and other equipment. 

Local organizations such as the Lions or the Rotary Club host these cardiac camps. They advertise the event, and arrange for patients to attend. An average of 400 people are screened at each camp, free of charge. When the diagnosis indicates the need for medical intervention, the patient is advised to visit the nearest NH hospital – where the procedure is performed at or below cost.

In addition to the clinical work, the NH doctors are actively involved in training the next generation of specialists. The institution runs 19 post-graduate programs for doctors and other medical staff. It offers the country’s only formal training program for pediatric cardiac surgery. NH has also initiated a scholarship program too, for talented students to attend medical school.

A separate department at the hospital co-ordinates the training of nurses, and offers degree and diploma courses for them to attend. To encourage girl students from remote areas to take advantage of these educational opportunities, NH arranges to guarantee bank loans that cover their fees and living expenses. In return, the trainee nurses work at the hospital during their course and for up to two years afterward. This helps to supply the much-needed manpower. The NH nurses are well recognized across the region for their superior abilities as well as dedication. 

NH studies its profit and loss account on a daily basis. By closely monitoring the profitability, its doctors can accurately assess the amount of concession that they are in a position to provide to the deserving patients without adversely impacting the institutional sustainability. When the monthly revenues are low, the doctors postpone the non-urgent subsidized surgeries. 

One-third of the NH patients treated at subsidized rates are economically disadvantaged people who are unable to afford the treatment anywhere else. They would just perish in the absence of medical attention. Fortunately, NH has never had to turn away a patient for the lack of funds.

The Strategic Pillars

NH seeks to revolutionize healthcare in India by bringing together quality, affordability, and profitability. It has been able to do so in the tricky field of healthcare, which includes sophisticated, delicate and risky medical procedures such as cardiac surgery. An innovative strategy has been framed to support the accomplishment of NH’s mission and vision. 

The institutional strategy rests upon four main pillars: a) process innovation, b) economies of scale, c) deployment of Information Technology and d) supply chain efficiency.

Process Innovation

NH has innovatively transformed the complex process of open-heart surgery in order to significantly bring down the cost while enhancing the quality. Many of the principles and practices of the modern industrial organization have been deployed in doing so.

NH leverages the hierarchy of medical talent in optimizing its surgical procedures. Its doctors operate in medical teams that comprise of a specialist, junior doctors, trainees, nurses and the paramedical staff. 

A bypass surgery typically takes about five hours. The nurses and the paramedics help to prepare the patient for surgery. The junior doctors harvest the veins/arteries, open and close the chest, and carry out the suturing. The critical surgical process of grafting takes only one hour, and is carried out by the specialist. This arrangement saves the specialist’s time, and leaves him free to perform more surgeries. 

The general industry norm is that the cardiac specialists are paid on a per surgery basis. However, NH invites its staff surgeons to work for fixed salaries. While the remuneration is handsome and competitive, the doctors are required to work much longer hours and perform more surgical procedures. At an average of 24 surgeries a week, the typical NH surgeon is far more productive than his counterparts across the globe. Thus, NH spends only 22% of its revenues on staff salaries. The comparable ratio for the hospitals in the West is up to 60%. 

Specialization is NH’s mantra for achieving high quality. On account of the large number of cases they handle, NH doctors acquire world-class expertise in particular clinical areas and operations. In order to facilitate the development of expertise by the doctors in their specialty area, NH provides for ample support staff and facilities to assist them. It also offers a series of structured capability building programs that every staff member is required to attend.

NH has been innovative in other ways too. When it set up a 104-bed hospital in the Cayman Islands in the Caribbean, it employed the cold water available from the sea in place of the energy-intensive refrigeration system. The resultant energy savings were to the tune of 90 per cent. This is very significant, considering that the cost of power in the Islands is three times that in the United States. Also, NH decided to set up an oxygen plant locally rather than source the gas supply from the mainland. 

Economies of Scale

NH is able to actively leverage the economies of scale, because its huge hospitals attract a large number of patients. The high volumes help to reduce the unit cost of surgery, and also lead to improved clinical outcomes because the doctors gain expertise and specialization in specific types of operations. 

Frugality is the watchword at NH. The institution implements cost saving methods such as the use of digital X-rays rather than the more expensive films. The use of infrastructure is also maximized in order to serve a large volume of patients, resulting in lesser unit cost.

For instance, while most hospitals employ their CT scanners, MRI, and other machines for only eight hours a day, NH uses them for 14 hours each day. The proper maintenance of the equipment is also emphasized, so that its life may be extended to the maximum.

Further, NH designs and executes its hospital projects with a view to maintaining a very tight control on the construction costs. Instead of buying expensive medical equipment outright, NH pays the supplier a fixed monthly rent in addition to the cost of the reagents that are necessary to run the tests on these machines. Equipment suppliers make a reasonable profit on account of the high volumes. They also project the successful deployment of the machine in NH’s demanding operational environment as the ultimate proof of its robustness.

To achieve the scale that it is looking for, NH also engages in collaborations and associations with other institutions. For instance, it entered into a management contract with respect to the MMI Hospital at Raipur in Chhattisgarh. After taking over, NH increased the number of beds, introduced health packages to enhance preventive health care, equipped the radiology department with the latest equipment and also upgraded the Emergency and Trauma Care Centre at the facility. 

West Bengal’s Durgapur Medical College is now entirely managed by NH. The institutionhas also set up embedded heart centers in other hospitals such as Chinmaya Mission, MS Ramiah Mission and St. Marthas – on a revenue-sharing basis.

Deployment of Information Technology

NH has invested in technology, both for clinical purposes as well as for integrating its systems and processes. The institution has implemented an Oracle ERP-on-cloud system that provides detailed, real-time information to all its important stakeholders. 

The extensive use of Information Technology ensures rapid transmission of disease data, quicker diagnostic analysis, and prompt disease management. The inventory and the processing times are also reduced through the use of comprehensive hospital management software. 

NH has also deployed technology in order to clearly define its systems and processes. Besides the clinical area, the protocols also cover the manner in which a patient is received and transferred from one place to the other and even how the medicines are to be indented. The streamlining of operational procedures has helped to achieve better quality, and reduce the error rates. This translates into reduced cost and greater satisfaction, since the patients get back home sooner.

NH also mines data extensively to raise its quality levels. Its business intelligence model throws up real-time information on 30 different parameters that the institution’s management may want to track for the improvement of efficiency. NH also maps out the performance of each doctor in terms of clinical outcomes as well as financial data such as the consumables used during surgery, the time spent by the patient in the ICU, and the total duration of stay in the hospital. 

Supply Chain Efficiency

NH operates its supply chain with a focus upon streamlining its administrative and clinical functions, continuous process innovation, and economies of scale. The institution does not sign long-term contracts. Major purchases are negotiated afresh every week, in order to avoid getting locked in with potentially expensive suppliers. 

The institution also procures the requisite consumable items in bulk. For instance, it saves about 40% on the cost of surgical gloves by importing them in container loads directly from the Malaysian manufacturer. This way, it saves on the distributor margins too. 

Given its large scale, credibility and high patient volumes, NH drives a hard bargain when negotiating prices for everything from basic supplies to sophisticated medical equipment. 8For example, the cancer hospital purchased two linear accelerators (for producing X-rays) for the price of one machine. Further, the interest-free payment schedule was spread out over seven years.

Health Cities

India currently has around 0.7 hospital beds per thousand people. In order to align that abysmally low number with the huge population of the country, NH is creating a chain of very large, self-sufficient “health cities” situated on the outskirts of some of the major cities in India. 

Each Health City is conceived to comprise of a set of well-equipped multi-specialty hospitals with a total capacity of around 5,000 beds. Every constituent hospital would have its own Operation Theatres and Intensive Care Units, but would draw upon common facilities such as the laboratory and the blood bank.

The logic for the Health City is two-fold. Firstly, it enables NH to extend its concept and brand of affordable health care to other specialty areas by building upon the reputation and experience that it has gained in cardiac care. Secondly, NH had reached a plateau in cost reduction because some of its medical equipment and facilities such as the blood bank remained underutilized. The newer specialty units within the Health City shall utilize these facilities, and thus enable further reduction in unit costs. 

For instance, the Institute for Bone Marrow Transplant (BMT) at NH’s Bengaluru facility has managed to reduce the cost of bone marrow transplants by two-thirds from the national average of Rs. 12 lakhs. The blood bank previously discarded unused blood after 10 days, as it was unsuitable for cardiac surgery. It is now able to utilize the blood for BMT procedures up to 26 days after its collection. 9

The first Health City has emerged around the original NH facility at Bommasandra in Bengaluru. The non-cardiac specialty units have been housed in new buildings that are constructed in an area of 35 acres adjacent to the cardiac hospital. The medical complex now houses a 1200-bed cancer hospital, a 500-bed orthopedic hospital, an eye hospital as well as medical education and research facilities.

Awards and Recognition

Over the years, NH has received numerous awards. These are a testimony to its strong brand value and work ethic. These include the “Healthcare Excellence Award for Addressing Industry Issues” in 2012, “Arcelor-Mittal Boldness in Business Award” in 2013 and the “Health Brand of the Year” in 2017. 

In addition, Dr. Shetty has personally received a number of national and international awards. This includes the “Padma Bhushan” (India’s third highest civilian Award) in 2012 for his contribution to the field of affordable healthcare. He has also received The Economist’s “Innovation Award for Business Process” in 2011 and The Economic Times “Entrepreneur of the Year” award in 2012, among others. 10

Concluding Reflections

NH weds noble intentions with a sound economic model. The institution is able to tie together high quality with affordability in a manner that is surprisingly profitable too. 

The doctors at NH are so committed to the institution’s vision and lofty sense of purpose that hardly any of them leave or go away. Like all organizations that pursue bold dreams, NH manages to inspire its employees and associates to routinely achieve the impossible – day after day. 

Over the next five years, NH is likely to become the largest hospital chain in India. It plans to increase its total number of beds to 30,000, and attract more doctors and other staff members who subscribe to its mission and vision. The institution also hopes to further reduce the cost of heart surgery to about $800.

The lack of skilled manpower (doctors, nurses and paramedical staff) has been a constant and significant challenge for NH in the past. This situation is likely to continue into the future too, as India’s recurrent shortage of two million doctors remains unaddressed. Thankfully, the National Skill Development Council is beginning to train the paramedical workforce in greater numbers. 

Posterity would remember Dr. Devi Shetty for saving thousands of infant lives, but even more for helping severe that unfortunate umbilical cord which links quality health care to affluence. Through the success of Narayana Health, he has demonstrated that hard work and dedication can help to fulfill the most challenging of missionary endeavours – particularly when the person’s “heart” is in the right place!

References

  1. Louis D. Brandeis Quotes [Internet]. BrainyQuote. [cited 17 May 2016]. Available from: https://www.brainyquote.com/quotes/louis_d_brandeis_130143
  2. Investor Presentation [Internet]. Narayanahealth.org. 2018 [cited 17 May 2018]. Available from: https://www.narayanahealth.org/sites/default/files/announcements/InvestorpresentationandcallinviteQ3FY18.pdf
  3. Alloubani A, Taktak W, Hussein A, AlZanoun R, Rabadi H, Feeney L. NARAYANA HRUDAYALAYA CARDIAC CARE HOSPITAL FOR THE POOR: LEADERSHIP CASE STUDY ANALYSIS AND KEY LESSONS FOR JORDAN. European Scientific Journal. 2014;10(25).
  4. Narayana Health [Internet]. Medicalbuyer.co.in. 2018 [cited 17 July 2016]. Available from: https://www.medicalbuyer.co.in/index.php/hospital-update/17991-narayana-health
  5. Singh H, Padmanabhan A, Emanuel E. India as a pioneer of innovation. 1st ed. New Delhi: Oxford University Press; 2017.
  6. Narayana Hrudayalaya Heart Hospital: Cardiac Care for the Poor (A) [Internet]. Courses.edx.org. 2017 [cited 9 July 2017]. Available from: https://courses.edx.org/asset-v1:HarvardX+SW47x+2T2017+type@asset+block/7-page_505078.html
  7. Tinsley E, Agapitova N. Inclusive Innovations [Internet]. World Bank Group; 2017 [cited 9 May 2018]. Available from: https://www.innovationpolicyplatform.org/system/files/2_%20Health%20Telemedicine%20Case_Jun
  8. Narayana Hrudayalaya: A Model for Accessible, Affordable Health Care? – Knowledge@Wharton [Internet]. Knowledge@Wharton. 2010 [cited 9 July 2016]. Available from: http://knowledge.wharton.upenn.edu/article/narayana-hrudayalaya-a-model-for-accessible-affordable-health-care/
  9. Narayana Hrudayalaya Heart Hospital: Cardiac Care for the Poor (A) [Internet]. Courses.edx.org. 2017 [cited 9 May 2018]. Available from: https://courses.edx.org/asset-v1:HarvardX+SW47x+2T2017+type@asset+block/12-page_505078.html
  10. Dr. Devi Prasad Shetty [Internet]. Narayana Health. [cited 9 July 2016]. Available from: https://www.narayanahealth.org/leadership/board-of-directors/dr-devi-shetty

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