Karnataka: How a govt hospital is giving corporate ones a run for their money

Jayadeva hospital is the largest centre for heart care in southeast Asia

58-Manjunath-director-of-the-Sri-Jayadeva-Institute Leading from the front: Dr C.N. Manjunath, director of the Sri Jayadeva Institute of Cardiovascular Sciences and Research, inside a cath lab at the hospital | Bhanu Prakash Chandra

The Bannerghatta Road in Bengaluru is known for not just multinational tech giants and malls, but also for big corporate hospitals. A swanky building nestled in a vast plot of lush gardens in Jayanagar is very likely to be mistaken for a private hospital, but the Sri Jayadeva Institute of Cardiovascular Sciences and Research is a government-run autonomous institute, the largest centre for heart care in southeast Asia.

Last year, Jayadeva performed 5,500 open heart surgeries and 3.78 lakh echocardiograms―the highest in the world.

As you step inside, there is a serpentine queue in the waiting lounge, but the admission desk and the billing counter do not seem like a barrier to access treatment. At least 80 per cent of the patients are treated free as they are covered under government health insurance schemes or by the hospital’s corpus fund. Known popularly as Jayadeva hospital (named after the family deity of the land donor), this research centre with 1,150 beds, located on a sprawling 13-acre campus, is a major landmark in the IT city. With campuses in Mysuru and Kalaburagi as well, Jayadeva now has around 2,000 beds exclusively for heart care.

According to the latest reports, Jayadeva had 6.55 lakh outpatients and 68,902 admissions last year. It performed 5,500 open heart surgeries and 3.78 lakh echocardiograms―the highest in the world. The success story of the public heart institute began with a doctor’s dream of scaling up a government hospital into a “five-star” hospital. Dr C.N. Manjunath, 66, is the man behind the dream, transforming Jayadeva into one of Asia’s leading cardiology centres. Manjunath graduated from Mysore Medical College, did his post graduation from Bangalore Medical College and doctorate of medicine in cardiology from Kasturba Medical College, Manipal. He joined Jayadeva in 1989 and was elevated to the post of director in 2006.

“It was not just about physical infrastructure like the building and equipment, but about nurturing talent and developing a culture of hard work and discipline,” said Manjunath, who was awarded the Padma Shri in 2007. “We mean every word of our three slogans: ‘Treatment first, payment next’, ‘Life is more important than the file’ and ‘Humanity is priority’.”

Jayadeva employs 120 cardiologists, 48 cardiothoracic surgeons, 40 cardiac anaesthetists and six vascular surgeons who run its 18 cath labs and 17 operation theatres. The hospital sees 1,500 to 1,700 walk-in patients every day and 80 per cent of them are below poverty line. ‘The poor families with no BPL cards or [those who] have lost the cards should still get treatment. But the rule book says the card is a must. I raised the issue in the governing council way back in 2007 and sought to authorise the director to identify the poor for free treatment. My eyeball assessment has only grown stronger as I see poverty and helplessness in their eyes before I see their ailing heart,” said Manjunath.

He still remembers the case of an elderly man who needed a pacemaker. “His son had borrowed Rs78,000 for the procedure and they had no BPL card,” said Manjunath. “When he learnt that the pacemaker would cost more than what he had, he decided to take his father back to the village. We absorbed the cost and performed the surgery as we had a corpus fund to fall back on.”

When he took over as director, Manjunath had a plan to build a corpus fund. He requested his employees for a day’s salary before requesting help from government organisations and NGOs. He also asked his staff to withdraw all cases against the hospital on salary and service issues. The hospital then put in place an incentive system to enhance employee productivity.

61-Inside-the-paediatric-ward-at-the-Jayadeva-hospital Handling with care: Inside the paediatric ward at the Jayadeva hospital | Bhanu Prakash Chandra

An audit by the accountant general lauded the hospital for being a great model for internal finance management and resource mobilisation despite a 37 per cent deficit in grants allocation by the government. “Ayushman Bharat and Arogya Karnataka insurance schemes are benefiting the poor. But they do not cover many procedures and the rates are not scientifically revised from time to time. The entire patient load falls on the government hospitals,” said Manjunath. He managed to raise a corpus of Rs150 crore to provide free treatment to the poor, who could not be covered under the government health insurance schemes.

The 400-bed hospital in Mysuru (started in August 2018), the 350-bed Infosys Foundation block (November 2021) and the upcoming 350-bed hospital complex on the new Jayadeva campus at Kalaburagi have helped the hospital achieve a rare feat―a staggering 2,000-bed dedicated facility for heart care.

On December 24, 2018, Infosys founder and chairman emeritus N.R. Narayana Murthy visited the hospital and said he was impressed with the hygiene and the quality of service. But he noticed the long queue at the outpatient department and also found that the wards were full. A day later, Manjunath got a call from Infosys Foundation chairperson Sudha Murty. “She told me that she wanted to build a 200-bed facility on the existing campus. But after her team of architects and engineers inspected the hospital complex, she called in to say that they decided to build a 350-bed hospital block. In November 2021, the Infosys wing became fully functional with two cardiac cath labs, two operation theatres, 100 ICCU (intensive coronary care unit) beds and 250 general [beds],” said Manjunath.

The Kalaburagi hospital serves Kalyana Karnataka, among the most backward regions in the state. Before Jayadeva opened its facility there, patients had to travel more than 700km to Bengaluru or to neighbouring states to receive cardiac care. When the new hospital came up in Kalaburagi, the first task was to recruit and train people to help them adapt to Jayadeva’s patient-centric work culture. “We selected 110 new recruits from Kalaburagi for the posts of nurses, technicians and doctors. Some recruits asked me whether the working hours were only till 1pm, which was the practice in the Kalyana Karnataka region, owing to the extreme heat in the afternoon. I inducted them in our Bengaluru main hospital three months in advance and drove them back to Kalaburagi on a bus on the day of the inauguration. In Bengaluru, they had first-hand experience of working in a hospital where the constant flow of patients can be overwhelming and exhausting. But the team realised the importance of the organisation in serving the needy,” said Manjunath.

The Cardiac Rehabilitation Centre (CRC) was set up in 2019 in collaboration with the Needy Heart Foundation and the Bangalore Indiranagar Rotary Trust, to help cardiac patients make lifestyle modifications. “Often, we see patients living in fear after suffering a heart attack. They feel depressed and anxious over not being able to go back to their routines. The CRC team visits the ward before the patients are discharged and counsels them on healthy lifestyle, diet, exercise and medicines,” said Dr S.P. Shankar Sira, who heads the CRC.

The newer additions to the growing list of specialisations in the institute are paediatric cardiology, vascular surgery and electrophysiology. Dr K.S. Ravindranath, professor of cardiology and chief academic officer, said, “We are now treating the highest number of rheumatic heart disease patients in South Asia. Doctors from western countries come to us for observership.” NABH (National Accreditation Board for Hospitals and Healthcare Providers) accreditation is a rare honour for a public hospital and Manjunath took it up as a challenge to upgrade Jayadeva on par with corporate hospitals, making it patient-centric, competitive and with world-class service. In 2015, Jayadeva became the first public heart institute to get NABH accreditation.

“For private hospitals, accreditation might work like a marketing tool. But we are already handling a huge patient load and would like uniformity in care and focus on the standards and compliance which help us streamline the system. It brings everyone in the hierarchy on the same page and builds accountability to safeguard our trust and credibility,” said Ramesh Shivanna, quality coordinator of the hospital.

Attrition or brain-drain can cripple health care institutions. But Jayadeva has been fortunate to have low attrition rates, despite the lure of corporate hospital jobs. Dr Karthik Raghuram, who did his DM in cardiology from Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, joined Jayadeva two years ago, opting for a government hospital as it offered a great learning experience. “It makes you feel good to serve the poor who might not have health insurance. Our equipment, imaging technology, valves, balloons or procedures are comparable to that of world-class hospitals,” said Karthik, who sees around hundred patients a day.

Dr Seetharama Bhat, senior consultant and professor of cardiac surgery, said the best part of working at Jayadeva was that doctors enjoyed a free hand to decide the course of treatment without worrying about the cost, the case-sheet and the reimbursement procedures. “Dr Manjunath has consistently raised funds to treat the poor and most donors are still with us only because of the rapport and respect they have for him,” said Bhat.

Till date, Manjunath has performed around 55,000 cardiac interventions. He innovated a new technique of balloon mitral valvuloplasty (an intervention to open up a thickened heart valve) which is now called ‘Manjunath’s technique’. The left atrial thrombus classification is done according to a scheme proposed by Manjunath, called ‘Manjunath classification’. He has trained cardiologists from the US, France, the UK, China and Vietnam in valvuloplasty procedures.

“Dr Manjunath’s zeal to teach, his simplicity, his respect for other points of view and his ability to take everyone along make him a leader,” said Ravindranath, who took Manjunath on board as a syndicate member when he was vice chancellor of the Rajiv Gandhi University of Health Sciences, Bengaluru.

Manjunath has defied the myth that clinicians do not make good administrators. He got the idea of building a “five-star” hospital after visiting the University of Alabama Medical School. But he gratefully acknowledges the loving nudge he got at home to do better each day from his wife Anusuya, daughter of former prime minister H.D. Deve Gowda. “She constantly reminds me that my profession is my first wife and she, the second.” But lakhs of cardiac patients will thank the couple for their selfless service.