One of India’s best-known healthcare brands, Manipal Group prides itself on clinical excellence and a patient-centric approach. From humble beginnings in 1953 as a single teaching hospital—the Kasturba Medical College—in a university town in Karnataka, India, Manipal Group has grown to a presence in seven cities in India and operations in Malaysia and Nigeria. “Our founder, Dr T. M. A. Pai, established Kasturba Medical College just six years after India gained independence,” says C. G. Muthana, Chief Operating Officer, Teaching Hospitals, Manipal Health Enterprises Pvt. Ltd, part of Manipal Group.

Manipal Health Enterprises Pvt. Ltd operates 11 corporate, or for-profit, hospitals and five teaching hospitals. “We have about 7,000 beds India-wide, and on that measure, we are the third-largest private-sector healthcare provider in India today,” says Muthana. The organization now employs about 6,000 people in its corporate hospitals and 5,000 people in its teaching hospitals.

Manipal Health Enterprises Pvt. Ltd acquires and operates world-class medical technologies in its teaching and corporate hospitals. However, with 75% of corporate hospital wards allocated to fee-paying private patients—compared to just 25% of the wards in teaching hospitals—the differences in information technology budgets are significant. “In the general wards that comprise most of the wards in teaching hospitals, patients are typically treated for free or at heavily subsidized rates,” explains Muthana. “So revenues and costs of delivery vary between hospitals, while employee costs remain similar.”

Rostering nurses a critical task

Rostering nurses to work shifts is one of the most important tasks at Manipal Group corporate and teaching hospitals. As at all hospitals, nurses administer medications, monitor patients, maintain records, manage intravenous lines, and work with doctors to heal patients. They can also provide advice and support to patients and loved ones, including teaching them how to administer medication outside a hospital setting. If too few nurses are rostered for a particular shift, the quality of patient care may suffer.

Google Cloud results

• Enabled the hospital to correctly size its nursing workforce
• Lowers stress on nurses by delivering more equitable rostering
• Presents opportunity to better manage nurses’ leave and other administration tasks

However, rostering at the group’s hospitals was a time-consuming exercise. Senior nurses on each ward would have to spend up to 45 minutes per day manually amending paper-based rosters to accommodate requested changes to duty shifts for personal or other circumstances. The organization began receiving complaints from patients, doctors, and other hospital staff that, on occasion, too few nurses were rostered on for certain shifts—particularly at its flagship hospital in Bangalore. “We had based our rostering calculations on the number of beds occupied by patients and, when we investigated, we found at a macro level, we were rostering on the correct number of nurses,” says Muthana. “However, on some days, on wards optimally staffed by, say, 10 nurses per shift, we might have 14 nurses rostered on for one shift and seven rostered on for another shift. Those times we had seven, we had a clear shortage.”

In 2012, Muthana asked a consultant to develop algorithms to help automate the rostering. “Unfortunately, there were so many variables, the consultant failed to solve the problem,” he says. The Chief Operating Officer’s next step was to ask the founder and Chief Executive Officer of predictive analytics business Retigence Technologies—already working with the business on a materials management project—to develop an application to manage rostering.

Removing the daily drudgery

“Our plan with the automation project was to relieve our senior nurses of the daily drudgery of amending the rosters and to deliver rosters that were as fair as possible to all our staff,” says Muthana. “We also saw an opportunity to reduce our costs by reducing the overall number of nurses needed to look after our patients.”

Retigence Technologies’ team members then worked with the group’s nurses to capture the variables and requirements for the project. For example, a minimum number of nurses with one year experience or more needs to be rostered on for each shift. Retigence Technologies then started building an application using compute resources available through Compute Engine, a Google Cloud product. “We selected Google primarily because of its pioneering work in artificial intelligence (AI) and machine learning,” says Srinibas Behera, founder and Chief Executive Officer of Retigence Technologies.

With the nurses rostering application developed, Manipal Health Enterprises Pvt. Ltd undertook several pilots to build user acceptance. “Some of our senior nurses took time to accept the fact automation removed their control over rostering assignments, but were finally convinced by the better transparency the product offered,” says Muthana. The organization deployed the application to a smaller hospital and secured user support before rolling out the application to its Bangalore flagship.

Eliminating stress

Deploying the application has enabled Manipal Health Enterprises Pvt. Ltd to remove a buffer of about 100 nurses retained to accommodate the variations in number of nurses rostered for individual shifts. “The savings on those salaries more than paid for the cost of developing the application,” says Muthana.

The application also enabled the organization to reduce the stress on nurses—both the nurses in charge of the rosters and the nurses subject to the rosters. “Night shifts were more equitably distributed among the nurses, while we have been able to reduce the 45 minutes per day required to amend rosters to just 10 minutes,” says Muthana. “In Bangalore alone, we have 51 nurses in charge of rostering—so the combined saving there equates to nearly 30 hours per day.” This is freeing up these senior nurses to complete more important tasks.

The application was subsequently implemented at Kasturba Hospital, Manipal, again reducing the time needed to generate complete nursing rosters to less than 10 minutes.

Managing leave and training

The organization now plans to extend the application to manage leave and training for its nurses and other employees. “I would like to see every employee given an annual leave plan that is added to the roster at the start of the year,” says Muthana. “The flexibility and control afforded by the application would enable us to address challenges such as managing leave across a workforce with high attrition rates.” The organization would also be able to create a calendar to ensure nurses receive all their required training.

“We also plan to keep fine-tuning the application to deploy nurses more efficiently and continue to reduce their stress levels,” adds Muthana. “We also want to create a nursing load indicator tailored to patients’ specific circumstances. For example, a sedated patient may not require much nursing care, whereas a patient who comes in with a broken leg and may be on a ventilator may require assistance from three nurses at once.” The business plans to use Google’s AI and machine learning APIs in the future to improve the value and user experience of the product.

Why Higher Ed Needs to Go All-in on Digital

In the wake of the COVID-19 pandemic, the majority of students within the 18-24-year-old demographic now expect hybrid learning environments–even once we are beyond the pandemic. And a vast number of adult learners are seeking options that accommodate their work and family lives now that it’s clear that effective learning can indeed occur virtually. Implementing cloud technologies and achieving digital maturity within higher education will enable institutions to be innovative and responsive to evolving student preferences, while being prepared for future disruptions.

The state of digital maturity

In February and March 2021, Boston Consulting Group (BCG), in partnership with Google, surveyed U.S. higher education leaders on their views of the state of digital maturity in the higher education sector. This survey found that institutional and technology leaders strongly agreed that moving legacy IT systems to the cloud, centralizing and integrating data, and increasing the use of advanced analytics is necessary to make a successful digital transformation, and ultimately achieve digital maturity.

But what is digital maturity? Digital maturity—a measure of an organization’s ability to create value through digital delivery—focuses on three areas of technological advancement that drive large-scale innovation:

1. Using cloud infrastructure
2. Expanding access to data
3. Using that data to improve processes through advanced analytics, such as Artificial Intelligence and Machine Learning (AI/ML)

Although university leaders agree on prioritizing digital maturity, more than 55% said they considered their schools to be “digital performers” or “digital leaders.” However, only 25% of tech leaders at these universities stated that their schools regularly use data analytics. As with corporations and governments, higher education institutions face barriers to technological innovation, such as:

• Competing priorities to meet step-change goals and decentralized decision making
• Budget constraints
• Cultural resistance to change
• Tech staff skillset gaps

Still, leaders understand that the way to overcome institutional inertia is with a strong, goal-oriented vision of what is best for the institution overall. Although only a handful of schools have reached digital maturity as we define it, others can learn a great deal from their examples. Here are the top takeaways from higher education leaders who successfully transformed their institutions:

Digital solutions can improve the student journey in many ways

As digital capabilities hold the key to dealing effectively with declining enrollment and rising costs, higher ed leaders identified four goals that are critical to improving performance:

1. Improve the student journey
2. Increase operational efficiency
3. Scale computing power in advanced research
4. Innovate education delivery

The research found that technology investments can help enhance the student journey in the recruiting and retention of students, improving digital education delivery, government funding, and donations from alumni. Digital maturity can make institutions more agile and efficient in delivering education that aligns with the changing societal norms, evolving student preferences, and future disruptions. Survey participants shared that they plan to increase the use of the cloud by more than 50% over the next three years. By shifting legacy IT systems to the cloud, institutions can increase scalability, lower the cost of ownership, and improve operational agility, while offering a more secure, long-term data storage solution.

Cloud-native software-as-a-service (SaaS) solutions provide an excellent platform for centralizing data. However, institutions that attempt to “lift and shift” their legacy systems to the cloud may encounter challenges to achieving measurable improvements in data integration and cost reduction. Higher ed leaders must realize that centralizing data and transitioning to the cloud do not happen simultaneously.

Leaders who are able to articulate a strong vision and commitment will experience a more successful technology transformation. By linking their vision to specific needs, such as more effective recruiting, leaders will find their technology investments will have a more substantial return. University presidents should base their decisions about which systems to move, when, and how on desired performance outcomes.

Big visions become a reality with small steps. Small pilot projects are an excellent way to start the journey toward digital maturity. Small steps toward a significant transformation can reduce resistance to change, build positive momentum, and produce better student outcomes. Read the full report here. If you’d like to talk to a Google Cloud expert, get in touch.