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Aiming to Revive SKIMS to its Glory 

In an in-depth interview with Greater Kashmir Correspondent Zehru Nissa, Dr. Ashraf Ganai, Director of Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Soura, shares his vision for healthcare excellence, innovative initiatives, and the challenges of leading the premier medical institution in J&K
11:22 PM Nov 10, 2024 IST | ZEHRU NISSA
aiming to revive skims to its glory 
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SKIMS has been the first and last choice for people suffering from any ailment. Why is it so?

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SKIMS has substantially fulfilled the vision of its founder by delivering exceptional, specialized patient care, offering top-tier teaching and training. This is evident from its widespread popularity, with 4,500 to 5,500 patients visiting the OPD daily and 850 to 1,000 emergency cases seeking care. The institute's successful management of complex and challenging medical cases has established it as the ultimate recourse for those in need of any treatment throughout the region.

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While we take pride in our reputation, the absence of a structured referral system has also led to SKIMS becoming a destination for minor and routine clinical conditions. My goal is to address this aspect by streamlining patient intake, ensuring that the expertise of our highly trained staff and the use of our advanced medical equipment are optimized for cases that truly require specialized care.

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Has this faith and reliance led to over-stretching of resources at the institute?

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The immense popularity of SKIMS, while a testament to its excellence, has placed significant pressure on the system. It is crucial for the public to act responsibly and recognize that visiting SKIMS for minor ailments contributes to unnecessary crowding and strains resources.

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To address this, I am directing my department to focus on advanced surgeries, specialized treatment protocols, and high-end diagnostic investigations. This strategic approach aims to reduce the need for residents to seek specialized medical care outside the state.

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Additionally, in keeping with our social traditions, large numbers of visitors often accompany in-patients, which impacts sanitation, security, and overall patient services. This, in turn, can compromise treatment outcomes and patient satisfaction. Managing these challenges is essential for sustaining the high standards of care at SKIMS.

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Has patient load over the period of time impacted SKIMS’s key focus on academics & research?

While acknowledging that the high patient load reflects the widespread trust and popularity of SKIMS and offers invaluable opportunities for research due to the abundance of data and samples, we have proposed a strategic plan to manage patient flow and reduce the influx of cases involving routine ailments. I would like to list these for your readers:

Comprehensive Strategy for Patient Distribution: I am preparing a proposal to present to the government, advocating for the enhancement of peripheral hospitals' capacity to manage cases within their scope. This will ensure that SKIMS maintains its focus on academics and research while reserving its specialized care for complex, critical cases that require advanced expertise.

Commitment to Research Excellence: As the premier healthcare institution in the region, SKIMS has established a strong reputation for conducting high-quality research. Our faculty, scientists, and researchers are dedicated to groundbreaking work, leveraging the high patient volume for valuable insights and advancements in medical science.

Balancing Patient Care with Research and Training: To support our faculty and staff, we are implementing measures to develop their skills in advanced patient care while also protecting time for research and training. These strategies aim to manage patient load effectively, maintain our focus on specialized care, and strengthen our leadership in research and academics. By achieving this balance, SKIMS can continue to deliver exceptional healthcare services and remain at the forefront of medical education and research in the region.

Personal Involvement in National Research Networks: I have actively participated in numerous national research initiatives, such as GENOMINDIA, INDIAB, the PCOS Task Force, and the Tribal Task Force, among others. As Principal Investigator and Chief Coordinator, I have led some of the largest research projects globally, underscoring SKIMS' vital role in national and international research collaborations.

These efforts collectively ensure that SKIMS not only sustains its legacy of high-quality patient care but also bolsters its position as a leader in medical research and academic excellence.

For reducing the load on specialty departments, a Triage system was put in place for a brief time a few years back. Why was it rolled down?

The triage system is the best strategy for segregating the level of care and judicious resources. Although I have started Triage system in Emergency immediately after assuming charge but understand same screening strategy is required in OPD and a similar structed referral mechanism is required in periphery. I am going to take all these issues in time bound manner. However, it would need support and from a number of stakeholders and from Government.

Is State Cancer Institute fully functional.?

I received State Cancer Institute in  partial functioning mode and I have accelerated the process of its full functionality. We have already initiated procurement of State of Art Linear Accelerator, New MRI and lab equipment. Developing dedicated theatre complex and Cancer Diagnostic centre will be installed pending fund release by with Central government. The process has been initiated on fast track.  The Daycare Center will be inaugurated in coming days.

What are the key challenges facing SKIMS as on date and what could be the possible workable solutions?

As with any healthcare institution, SKIMS faces multiple challenges as of today. One of the key challenges is the lack of adequate faculty, paramedical staff, scientists, engineering and IT staff, lack of operational independence affecting the overall functioning of the institute, owing to tardy recruitments and superfast superannuation. It is strange that the engineering wing of SKIMS is no longer under our administrative control.

Additionally, the hospital faces challenges in terms of infrastructure, such as a lack of adequate space and equipment. We have already talked about the high volume of patient inflow, which lead to overcrowding and longer waiting times. To address these challenges, SKIMS administration has raised these issues with Government to allow recruitments, provide dedicated engineering wing and facilitate one time revival grant, among others.

Meanwhile, we have already initiated some alternative funding options like ICMR,DBT,DST CSIR, including support under CSR etc.

You would be interested in knowing that SKIMS has developed a roadmap to implement a structured patient referral system in collaboration with medical colleges and the Directorates of Health Services. This initiative aims to manage patient inflow and reduce overcrowding, ensuring that SKIMS can focus on providing specialized medical care. These measures will help improve services and maintain the institute's commitment to high-quality healthcare, aligning with its vision and mission.

You must have had your list of things to do when you took over as Director SKIMS. What worked and what needs tweaking?

Upon assuming office, I conducted SWOT analyses and engaged with departments, former leaders, and national/international experts to strengthen SKIMS.

Initial actions included restructuring patient services, particularly revamping the Emergency Area by creating a dedicated “Triage Centre,” shifting Pediatric Emergency, and setting up a 24x7 testing facility. These changes, along with placing Senior Residents and a Point-of-Care Lab, improved emergency care and streamlined triage.

Key achievements include streamlining OPD appointments, enhancing security and sanitation, and gaining accreditations for Colorectal Surgery Fellowship, DSIR certification, and ISO for the Biochemistry lab. We prioritized faculty development through expert-led sessions, established the NAMS cell, and expanded research partnerships.

Future goals include new specialized courses, infrastructure upgrades, and starting a Liver Transplant program, with a focus on telemedicine, regional health centers, and stakeholder engagement for innovation.

What are SKIMS patient care, academic & research plans for the future?

SKIMS has outlined a vision document focusing on enhancing patient care, academic excellence, and research.

Patient Care: We plan to streamline patient care with a structured referral system, including electronic processing and standardized protocols. Infrastructure upgrades aim for a paperless hospital within a year. Advanced patient management systems using validated algorithms and expanded telemedicine for remote areas are also prioritized.

Academic Excellence: SKIMS fosters top-tier medical education through postdoctoral to postgraduate programs and international collaborations (MoUs). Regular workshops, conferences, clinical audits, and departmental reviews enhance continuous learning. DPRs for centers of excellence in cardiology, neurology, and trauma are in progress.

Research and Innovation: Initiatives include a dedicated Research Cell, enhanced Faculty Research Day, and PGRP for evidence-based care. We promote interdisciplinary research focused on regional health. A comprehensive vision document was released during the recent PGRP inauguration.

How can we change the way we run hospitals in J&K - be it administration, infrastructure, efficiency or research?

I feel transforming hospitals in J&K requires a multifaceted approach with structured referral system as its backbone. Administratively, adopting digital governance, transparent procurement, and merit-based hiring can enhance accountability. Infrastructure upgrades, including modernization of equipment, buildings, and robust IT systems, can improve patient care. Additionally, adopting patient-centric care models, implementing quality accreditation standards, and leveraging technology like telemedicine, AI, and data analytics can significantly enhance healthcare delivery. Strategic planning, capacity building, and community engagement are also vital. By adopting these measures, I am sure that J&K's hospitals can become models of excellence, providing quality, accessible, and affordable healthcare to its citizens, and has a scope to become a medical hub for tourists

Shortage of faculty, doctors, nurses, and staff in other departments seems to be a major challenge. How do we tackle it?
Absolutely, the shortage of faculty and staff at SKIMS is a real challenge for us in providing top-notch patient care. Right after I stepped into my role, I kicked off some fast-track hiring initiatives, and I’m optimistic that, with the government’s backing, we’ll see an uptick in our staffing levels within a year. We’re also looking at improving the work environment and perks, similar to what you see at AIIMS Delhi, to keep our existing staff happy and attract new talent. Plus, exploring flexible roles for visiting professors and providing mentorship and training can really help with retention. By creating fellowship pathways, we can ensure a steady flow of qualified staff in the future.

Tell us about five best practices in healthcare other hospitals can pick up from SKIMS.
There are a few things we do at SKIMS that I think other hospitals would benefit from. First, we’ve got a patient-centric emergency care model with a dedicated triage center that really helps prioritize care for those who need it most. Second, our multidisciplinary care teams make sure we’re collaborating across departments for a more holistic approach to treatment. Third, we’re big on quality assurance; we’ve got accreditations from NMC and ISO, which keep us focused on patient safety and satisfaction. Fourth, our education and training programs are robust, including fellowship opportunities and hands-on training. Lastly, we leverage technology—like telemedicine and electronic health records—to streamline operations and improve patient care. These practices can help other hospitals enhance their services significantly!

How can we ensure health equity in patient care?
Ensuring health equity is really about addressing the bigger picture. We need to start by recognizing and tackling implicit biases within our healthcare teams through training and education. Patient-centered care models can help us tailor treatments to individual needs, which is crucial. Increasing diversity in our healthcare workforce also enhances cultural understanding and engagement with the community. We’re leveraging technology, like telemedicine, to reach underserved populations, and using data-driven approaches to identify and address health disparities. It’s all about ongoing assessment and a commitment to continuous improvement to make sure everyone receives the high-quality care they deserve.

How can we strengthen our primary healthcare?
Primary Health Centers (PHCs) are really the backbone of healthcare set-up. To strengthen them, we need to invest in modernizing their infrastructure and upgrading equipment to provide quality care. It’s also essential to recruit and train healthcare staff, especially in rural areas, and offer incentives to encourage them to stay. Technology can play a big role, too—using telemedicine can enhance access and efficiency. We should also ensure that these centers provide comprehensive services, from preventive to rehabilitative care, and establish solid referral systems to secondary and tertiary care when needed. By engaging local populations and partnering with NGOs, we can mobilize resources and support to make our PHCs vibrant hubs of care.

What are the biggest health threats J&K is facing?
Jammu and Kashmir has its share of health challenges, primarily driven by geography and socio-political factors. We’re seeing a rise in non-communicable diseases like diabetes and heart disease, along with mental health issues that stem from years of conflict. Substance abuse among the youth is also a growing concern. The region’s unique geography leads to altitude-related health risks too. Tackling these threats will take a comprehensive approach, focusing on developing healthcare infrastructure, supporting mental health initiatives, and implementing community-based programs. At SKIMS, we’re ready to take the lead in creating a structured plan for primary, secondary, and tertiary care that can serve as a model for other regions.

What sets SKIMS apart from other health institutions in J&K?
What really sets SKIMS apart is its legacy and commitment to excellence. Founded by Sheikh Mohammad Abdullah in 1983, we’ve grown into the largest tertiary and quaternary care institution in J&K. We offer specialized services that you won’t find elsewhere, like advanced surgeries and transplants. Plus, we’re a teaching institution on par with the likes of AIIMS, which means we’re not just providing care but also training the next generation of healthcare professionals. Our state-of-the-art facilities, emphasis on a multidisciplinary approach, and community outreach programs make us a vital part of the healthcare landscape in the region.

What is it about SKIMS that people must know?
People should know that SKIMS has been a cornerstone of healthcare in the region for over 40 years. We’re committed to excellence in patient care, education, and research, supported by modern infrastructure. Our goal is to provide high-quality tertiary care so that patients don’t have to seek treatment outside the state. It’s important for the community to understand that while we’re here for serious health issues, they should also utilize local services for routine concerns. This way, we can focus on our mission of providing the best possible care for those who truly need it.

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