Max Healthcare Institute Ltd Management Discussions

Overview

Max Healthcare is a leading healthcare provider in India, committed to the highest standards of clinical excellence and patient care, with an ecosystem ably supported by the latest technology and cutting-edge research.

Our Network consists of 19 healthcare facilities with over 4,000 beds (as of March 31, 2024), and includes all the hospitals and medical centres owned and operated by our Company and our subsidiaries, managed healthcare facilities as well as partner healthcare facilities (PHFs). These facilities comprise the state-of-the-art tertiary and quaternary care hospitals located at Saket (three hospitals), Patparganj, Vaishali, Rajendra Place, and Shalimar Bagh in Delhi NCR and one each in Lucknow, Mumbai, Nagpur, Mohali, Bathinda and Dehradun, secondary care hospital in Gurgaon and medical centres at Noida, Lajpat Nagar (two centres) and Panchsheel Park in Delhi NCR, and one in Mohali, Punjab. The hospitals in Mohali and Bathinda are in public-private partnerships (PPPs) with the Government of Punjab.

We recently commissioned the 303-bed Max Super Specialty Hospital, Dwarka in South West Delhi, which is being operated under the operations and management (O&M) agreement executed between Muthoot Hospitals Private Limited and Max Healthcare. The hospital, which commenced its in-patient and emergency department operations from July 2, 2024, is equipped with the latest high-end technology and has a staff strength of over 600 people currently.

Our services cover diverse healthcare needs, from routine checkups to complex surgeries. These include advanced cardiac care, orthopaedics, oncology, renal sciences, neurosciences, and transplants (liver, heart, kidney, lung and bone marrow), minimal access metabolic and bariatric surgery, obstetrics and gynaecology, paediatrics, nephrology, and general surgery. We also offer laboratory services, radiography, imaging, emergency care consultations for various illnesses as well as tests and screenings for preventive care. In addition to the hospitals, we operate homecare and pathology businesses – Max@ Home, which provides health and wellness services at home, and Max Labs, which provides diagnostic services to patients outside our network.

I. Indian Healthcare Industry

According to the latest projections by the International Monetary Fund (IMF), global growth was estimated at 3.2% in 2023 and is expected to maintain a similar momentum in 2024 (3.2%) and 2025 (3.3%). This growth rate is relatively low compared to historical standards, due to both short-term factors such as high borrowing costs and reduced fiscal support, as well as longer-term impacts from the COVID-19 pandemic. In contrast, Indias growth is projected to remain robust, at 7.0% in 2024 and 6.5% in 2025. This resilience is attributed to strong domestic demand and a growing working-age population.

The Indian healthcare industry significantly contributes to the countrys economy, employing approximately 7.5 million people as of 2024. Public expenditure on healthcare has seen a substantial increase from 1.4% in FY18 to 1.9% in FY24. This uptick in spending underscores the governments goal to position India as a global healthcare hub and plans to raise the public health spending to 2.5% of GDP by 2025.

Projections indicate that the hospital market in India, valued at USD 98.38 billion in 2023, is likely to continue its growth trajectory and expand to USD 193.59 billion by 2032, recording a CAGR of 8.0%.

Health insurance has also witnessed a substantial growth, with premiums underwritten by insurance companies amounting to H 1.09 lakh crore (USD 12.99 billion) in FY24.

The health segment now constitutes a sizeable 37.63% of the total gross written premiums (GWPs) in the country.

The Indian medical tourism market continues to expand, valued at USD 7.69 billion in 2024 and projected to reach USD 14.31 billion by 2029, growing at a CAGR of 13.23%. This growth is fuelled by Indias reputation for high-quality, cost-effective medical care.

Structure

Indias healthcare industry comprises hospitals, medical devices and equipment, health insurance, clinical trials, telemedicine and medical tourism.

Includes government (healthcare centres, district hospitals, and general hospitals) and private (nursing homes, mid-tier & top-tier private hospitals) entities

Comprises businesses and laboratories that offer analytical or diagnostic services, including body fluid analysis

Includes health insurance and medical reimbursement facility, covering an individuals hospitalisation expenses incurred due to sickness

Includes manufacturing, extraction, processing, purification and packaging of chemical materials for use as medications for humans or animals

Includes establishments primarily manufacturing medical equipment and supplies, e.g., surgical, dental, orthopaedic, ophthalmologic, and laboratory instruments

Has enormous potential in meeting the challenges of healthcare delivery to rural and remote areas besides several other applications in education, training and management in the healthcare sector

Key Facts

The Indian healthcare market is projected to soar to USD 638 billion by 2025 from an estimated USD 86 billion in 2016.

The hospital industry dominates the healthcare market, accounting for 80% of total spending. This sector is attracting significant investment interest from global and domestic investors.

There are approximately 70,000 operational hospitals in India, out of which 63% are from the private sector.

The countrys existing bed-to-population ratio is 1.3/1,000 population (private and public hospitals included), with a deficit of 1.7/1000 population, necessitating an additional 2.4 million beds to cater to the existing population.

The diagnostics industry is valued at USD 4 billion, with the organised sector accounting for approximately 25% of this value (15% in labs and 10% in radiology).

The MedTech Industry was estimated to be USD 10.63 billion in 2020 and will likely reach USD 50 billion by 2025. The healthcare sector is experiencing rapid growth, driven by improved coverage, services, and increased spending by public and private entities.

(Source: IBEF, FICCI,Niti Aayog, Economic Times, ET Health, HFS Research)

Development

Rapid growth in healthcare infrastructure

Hospitals will likely benefit from increased healthcare spending due to a demand-supply mismatch in bed capacity. This gap, coupled with longer life expectancy, heightened health awareness, and a rise in non-communicable diseases (accounting for about 70% of deaths in India), will drive demand for tertiary and quaternary care. The deeper penetration of health insurance and government schemes will further bolster this demand. Given Indias inadequate healthcare infrastructure, private hospitals are well-positioned to benefit from these trends.

The market share of large hospital chains is expected to grow. Private hospitals comprise 63% of the market, but large chains account for only 12%, according to latest research by Anand Rathi. Their ability to invest in bed capacity, attract clinical talent, and benefit from increased affluence, higher health-insurance penetration, and medical tourism will drive this growth. Expansion through brownfield projects and in established markets will likely lead to faster breakeven and maturity, leveraging existing demand and brand recognition.

Governments Healthcare Commitment

The Government of Indias 2024-25 budget plans to expand medical colleges by leveraging existing hospitals, building a firmer foundation for future healthcare professionals.

According to information provided in the Lok Sabha by the erstwhile Minister of Health & Family Welfare and Tribal Affairs, Dr. Bharati Pravin Pawar, the doctor-to-population ratio in India is 1:834. Per the information provided by the National Medical Commission (NMC), there are 13.08 lakh allopathic doctors registered with the state medical councils and the National Medical Commission (NMC) as of June 2022.

The Government of Indias recent approval of the National Health Mission with a budget of H 37,274 crore (USD 4.44 billion) under the Union Budget 2024-25 demonstrates a firm commitment to improving healthcare accessibility and infrastructure nationwide. This initiative aims to enhance healthcare services, particularly in underserved regions, ensuring broader access to quality medical care and improving overall health outcomes.

Key Trends in Indian Healthcare

Transition from Communicable to Lifestyle Diseases	Urbanisation and modern urban living have led to about 50% of in-patient bed spending attributable to lifestyle diseases, increasing demand for specialised care. In India, lifestyle diseases have supplanted traditional health issues.
	The primary causes of lifestyle diseases include high cholesterol, high blood pressure, obesity, poor diet, and alcohol consumption.
Rising Health Insurance Penetration	In FY24, health insurance premiums reached H 1.09 lakh crore (USD 12.99 billion).
	CRISIL MI&A Research highlights low penetration as both a concern and an opportunity for the growth of Indias healthcare delivery industry.
	With the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme and other growth drivers, insurance coverage will likely to rise to 47-50% by FY27.
	Increased health insurance coverage will likely boost hospitalisation rates and health check-ups, driving demand for a robust healthcare delivery platform.
Growing Adoption of Artificial Intelligence (AI)	Per a World Economic Forum (WEF) report, AI expenditure in India will likely reach USD 11.78 billion by 2025 and contribute USD 1 trillion to Indias economy by 2035. The AI in healthcare market will likely grow from USD 14.6 billion in 2023 to USD 102.7 billion by 2028.
	The increasing adoption of AI-based applications allows individuals to consult directly with doctors and physicians, receiving expert advice for optimal treatment.
	AI can potentially address challenges faced by patients, doctors, hospitals, and the healthcare industry.
Technological Advancements in Healthcare	Technologies such as digital health knowledge resources, electronic medical records, mobile healthcare, hospital information systems, technology-enabled care, and telemedicine are gaining widespread acceptance in the healthcare sector.
Point-of-care Treatment	Point-of-care testing involves conducting tests at or near the patients location, providing rapid results for immediate action.
	Standard point-of-care tests include blood glucose monitoring, home pregnancy tests, haemoglobin tests, faecal occult blood tests, rapid strep tests, etc.
	Point-of-care testing helps alleviate emergency room overcrowding by reducing treatment time and shortening patient stays.
Rise of Telemedicine	Telemedicine is rapidly growing in India, and virtual care, including teleconsultation, telepathology, teleradiology, and e-pharmacy, is gaining traction.
	A study by EY, in collaboration with the Indian Pharmaceutical Alliance, predicts that the domestic telemedicine market will reach USD 5.5 billion by 2025, based on surveys of consumers, doctors, and stakeholders from pharmaceutical companies and global research.

Growth drivers

Per Invest Indias projections, Indias hospital sector will likely witness a significant growth, increasing at a CAGR of 18.24%, to reach H 18,348.78 billion by FY27. Increased income and affordability, along with a rising elderly population and changing illness trends, have fuelled the demand for healthcare services. Indias emergence as a destination for medical tourism has further boosted this demand. Policy support has played a crucial role in driving growth, with initiatives such as promoting Foreign Direct Investment (FDI) and reducing customs duties on life-saving equipment. Government programs like the National Rural Health Mission (NRHM) have provided substantial funding for healthcare facilities. These factors, combined with a focus on research and development (R&D), distribution capacity, and promotion of public-private partnerships, have spurred innovation and development in the sector. Moreover, increasing mergers and acquisitions, driven by FDI and private sector investments, have led to foreign players establishing research institutes and hospitals, further contributing to the sectors growth.

• Rising income and affordability

Rising income levels in India translate to a growing ability to access healthcare and related services. Per IMF estimates, Indias per capita GDP has expanded by 59%, from USD 1,714.28 in 2016 to USD 2,730.77 in 2024, indicating significant economic growth. With more disposable income, individuals will likely be more willing to invest in preventive care and routine check-ups, increasing the overall demand for a range of medical services.

• Rising elderly populations and shifting illness trends

The changing demographics, particularly the increasing elderly population, will significantly impact healthcare trends. According to the ‘India Ageing Report 2023, published by the United Nations Population Fund (UNFPA), nearly one-fifths of Indias population will comprise people over the age of 60 by 2050. Combined with changing illness trends, this demographic change will necessitate focusing on healthcare services catering to the elderly and addressing the evolving health challenges associated with ageing populations.

• Increasing medical value travel

The presence of world-class hospitals and skilled medical professionals in India has strengthened its position as a preferred destination for medical tourism. The countrys superior quality healthcare, coupled with lower treatment costs compared to other countries, has benefited Indian medical tourism. Treatment for major surgeries in India costs approximately 20% of that in developed countries, making it an attractive option for medical tourists. India also attracts medical tourists from developing nations due to many patients need for advanced medical facilities. The Indian medical tourism market was valued at USD 7.69 billion in FY24 and will likely reach USD 14.31 billion by 2029. As per reported data, around 634,561 foreign tourists came for medical treatment in India in 2023, nearly 6.87% of the international tourists who visited the nation.

• Rising awareness and preventive care Indias healthcare sector has seen a significant increase in knowledge and awareness regarding wellness, preventative care, and diagnostics. This shift has led to a growing emphasis on preventive healthcare measures and early diagnosis of diseases. Integrating traditional practices such as yoga, meditation, and Ayurveda with modern healthcare has further enhanced the countrys healthcare offerings. The governments decision to allow 100% FDI in the AYUSH sector for wellness and medical tourism has also contributed to this trend. The establishment of the National Medical & Wellness Tourism Board and the publication of the National Strategy and Roadmap for Medical and Wellness Tourism are steps towards promoting and regulating medical and wellness tourism in India.

• Policy Support and Government Initiatives

Government policies and initiatives play a crucial role in shaping the healthcare landscape. They aim to enhance accessibility, affordability, and quality of healthcare services. These measures are designed to address critical challenges in the healthcare sector, promote innovation, and improve overall health outcomes for the populace. In the Union Budget 2024-25, the Ministry of Health and Family Welfare received an allocation of H 90,958.63 crore (USD 10.96 billion), marking a 13% increase from H 80,517.62 crore (USD 9.70 billion) in 2023-24 (revised estimate).

These are some of the significant policies and initiatives that are driving positive changes in the healthcare industry.

o Ayushman Bharat and Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): The Ayushman Bharat scheme, launched to ensure universal health coverage, has issued over 26 crore Ayushman cards and established over 1,56,000 centres, delivering primary healthcare services across India. The Ayushman Bharat Digital Mission (ABDM) has created over 450 million Health Account (ABHA) IDs, registered 2,19,546 health facilities, and onboarded 2,28,794 healthcare professionals, highlighting the significant adoption of digital tools in healthcare. The government employs AI and ML to prevent fraud and ensure proper treatment for eligible recipients. Under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), the Union Budget 2024-25 allocated H 2,200 crore to enhance medical education infrastructure by establishing new AIIMS and upgrading government medical colleges. As of February 2024, five new AIIMS have been inaugurated in Rajkot, Bathinda, Raebareli, Kalyani, and Mangalagiri, boosting tertiary healthcare facilities nationwide.

o Tax and Credit incentives: Tax incentives are promoting growth in healthcare. Education and training services are exempt from service tax, supporting skilled professional development. Private providers in non-metros with 50+ bed hospitals enjoy an extended tax holiday under Section 80-IB. A 250% deduction applies to approved tech-enabled services like telemedicine. New rural hospitals with 100+ beds receive a 100% profit deduction for five years under Section 80-IB, enhancing rural healthcare infrastructure.

o Vision 2035 – Public Health Surveillance in India: India aims to enhance its public health surveillance system to be more flexible and predictive, strengthening preparedness at all levels. This includes implementing a citizen-friendly system with consumer feedback processes to ensure privacy and confidentiality. Improvements in data-sharing systems between the central and state governments are also prioritised to enhance disease control measures.

Indias goal is to provide regional and international leadership in managing global health events, particularly public health emergencies.

o Digital India: India has made remarkable progress in healthcare digitisation, with over 1,000 digital / e-Hospitals established nationwide. This initiative is a vital component of the Indian Governments Digital India programme, which seeks to empower the nation digitally. By providing a digital platform for healthcare services, these e-hospitals contribute to the improvement of overall healthcare delivery in the country.

• Foreign Direct Investment (FDI) Inflow

Indias healthcare sector has been a magnet for foreign direct investment (FDI), with policies allowing 100% FDI under the automatic route for greenfield projects and up to 100% for brownfield projects under the government route. According to data from Ministry of Commerce and Industry, the hospitals and diagnostic centres segment witnessed significant FDI inflows between April 2000 and March 2024, reaching a cumulative fund infusion of USD 10.27 billion. During the year, the countrys hospital and diagnostic centres segment recorded an 89% increase in FDI equity inflows compared to the previous year.

Factors such as growing demand for healthcare, significant cost advantage, and supportive government policies have contributed to this influx. In recent years, there have been several notable investments from global healthcare providers and private equity firms in the hospital and diagnostic sectors. These investments have played a crucial role in the sectors growth, enabled improvement in accessibility to healthcare, brought in advanced medical technologies and expertise, and enhanced the overall quality of healthcare services in the country.

Industry Outlook

Indias healthcare sector is experiencing significant growth and transformation, driven by various factors, including increased government expenditure, rising health insurance penetration, and a growing demand for healthcare services.

The Indian hospital sectors market capitalisation has increased ninefold from H 375 billion in FY20 to H 3.5 trillion in FY24, owing to improved pricing, higher insurance penetration, and a focus on complicated treatments such as transplants. This trend is likely to intensify over the coming decade.

Per ICRAs latest projections, despite high base of FY23 and FY24, large private hospital chains will likely witness healthy year-on-year revenue growth of 12-14% in FY25, supported by stable occupancy levels and ARPOB. Operating profit margins will continue to benefit from cost optimisation measures and likely remain healthy at approximately 22-23% in FY25. Several industry players have announced sizeable greenfield and brownfield expansion plans and are actively scouting for inorganic opportunities. This is expected to lead to significant bed additions over the next two years, with leading private hospital players well-placed to execute these expansion plans while maintaining steady return on capital employed (RoCE) at 20-25%.

II. Opportunities and threats

Opportunities

Enhancement of healthcare infrastructure

According to the latest report by Knight Frank and Berkadia, India faces a deficit of 2 billion square feet of healthcare space for its population of 1.42 billion. Given the current bed-to-population ratio of 1.3 beds per 1,000 (with a deficit of 1.7 beds per 1,000), India will need an additional 2.4 million beds to meet the recommended three hospital beds per 1,000 people. This gap presents opportunities for public and private players to expand in Indias healthcare sector.

Through brownfield expansion, we are adding 1,264 beds in our existing hospitals and 1,792 beds at our partner healthcare facilities (PHFs). This expansion approach provides substantial operating leverage and is highly ROCE accretive due to much lower fixed costs and faster occupancy ramp-up. In the first quarter of this year, we expanded our hospital at Shalimar Bagh in Delhi NCR by 92 beds through such brownfield expansion.

During the year, we also extended our geographic footprint to two new cities – Nagpur and Lucknow, by acquiring two hospitals with ~750 beds and adding to our overall brownfield expansion potential.

We also acquired land parcels to build greenfield hospitals in highly attractive territories of Delhi, Greater Noida, Lucknow, Gurugram, and Punjab (Mullanpur, Zirakpur) with potential to add approximately 400 to 500 beds at each of these locations. These greenfield projects are situated in compelling markets with attractive payback periods, reinforcing our Companys growth trajectory.

We intend to significantly increase our Networks bed capacity by FY28, including expansion plans at some of our PHFs as well.

Hospital / Land Parcel	Type of expansion	Beds being added by FY28
Max Lucknow	Brownfield	590
Max Mohali	Brownfield	155
Nanavati-Max Mumbai	Brownfield	379*
Max Smart (Saket Complex) (PHF)	Brownfield	375
Sector 56, Gurugram	Greenfield	501
Max Nagpur	Brownfield	140
Max Vikrant (Saket Complex) (PHF)	Brownfield	550
Max Patparganj (Nirogi) (PHF)	Brownfield	367
Zirakpur, Punjab	Greenfield	250

*Net of 160 beds to be demolished before commencement of phase 2 construction

Strategic mergers and acquisitions

In addition to brownfield expansions, we frequently assess inorganic growth opportunities to expand our geographical footprint, service a larger share of patients, and allocate operational cash surplus strategically.

This year was noteworthy for us on several counts as we announced three transactions that enabled us to expand our presence to two new cities – Nagpur and Lucknow. We acquired the erstwhile Alexis Multi-speciality Hospital, Nagpur and Sahara Hospital, Lucknow, adding ~750 beds to our existing bed capacity, with both the hospitals having further expansion potential. These cities represent vital markets in the fast-growing and populous states of Maharashtra and Uttar Pradesh. We have renamed these hospitals Max Super Specialty Hospital, Lucknow and Max Super Specialty Hospital, Nagpur. We expect them to be the key drivers for future growth in these regions.

We also acquired approximately 5.4 acres of prime land at Shaheed Path in Lucknow with the potential to build around 550 beds. We will firm up the plans for this hospital once we turn around Max Lucknows operations.

In August, 2024, we have entered into an agreement to lease with Silicon Constructions Private Limited (SCPL) for a built-to-suit transaction to set up a 250-bed hospital at Zirakpur in Punjab. This hospital building, with 2.75 lakh square feet of built-up area and attendant parking, will be constructed by the developer (SCPL) as per our requirement and specifications. It is a long-term lease arrangement, extendable up to 50 years, and we expect to commission the facility by FY28, which will then cater to surrounding areas of Himachal Pradesh, Punjab and Haryana.

Expand retail pathology and home care businesses

In addition to our core hospital business, we are scaling up Max Lab and Max@Home operations to extend quality healthcare services beyond our facilities.

Max Lab

TheIndiandiagnosticsindustry,valuedatapproximately H 730 billion, will likely grow at a CAGR of 10-12% by FY25. We are initially focusing on expanding Max Labs presence in cities where we already operate our Network facilities. This approach includes expanding our network of third-party managed patient collection centres (PCCs), pick-up points (PUPs) in doctor clinics, and hospital lab management (HLM) services to enhance accessibility and convenience across Uttar Pradesh, Punjab, Haryana and Uttarakhand.

During the year, Max Labs revenue grew approximately 28% year-on-year, leading to a significant increase in EBITDA. This growth was driven by a 32% year-on-year increase in demand for the WellWise health packages, along with expanded operations spanning 41 cities by the end of the year. Additionally, the speciality tests segment experienced robust growth, expanding the portfolio to over 2,500 tests during the year compared to nearly 2,000 tests in the previous year, including high-end molecular and next-generation sequencing (NGS) tests. The average revenue per patient billing increased by over 10% year-on-year, attributable primarily to improved test mix and pricing strategy.

For the upcoming year, our priorities include leveraging the recently launched hospital operations in Lucknow and Nagpur to expand and establish networks in these cities. Additionally, we plan to expand into other promising territories of Maharashtra, Rajasthan, and Madhya Pradesh, while also exploring strategic partnerships with existing diagnostic lab service providers.

Max@Home

The Indian home healthcare market will likely surpass H 1.6 trillion by 2025, driven by a shift towards out-of-hospital care. Max@Home addresses this burgeoning market, providing comprehensive services in a sector poised for rapid growth. Potential growth levers include end-to-end clinical solutions, digitalisation, and deeper penetration in existing geographies, Max@Home aims to enhance access, affordability, and patient care quality.

During the year, Max@Home recorded growth across various facets of its business, driven by its commitment to delivering superior out-of-hospital care. It reported a gross revenue of H 172.4 Crores, marking a robust

24% year-on-year increase. The long-stay business line demonstrated remarkable performance with a 33% growth, contributing significantly to its overall revenue. Additionally, the Occupational Health Centres (OHCs) business grew by 37%, adding over 30 new OHCs and expanding its presence across 12 cities. Transactional services also grew steadily, with approximately 1.4 lakh transactions in FY24. Further, Max@Home received its fifth consecutive accreditation from the Quality Accreditation Institute (QAI), the sole provider of home healthcare accreditation in India.

With strategic initiatives for introduction of new service and product lines, market expansion of Max hospital operations, a strong focus on quality, and ongoing technology investments, Max@Home is poised for sustained growth in the years ahead.

Case mix and payor mix improvement

We continue to invest in cutting-edge medical technology and strengthen our clinical teams to expand our tertiary and quaternary care capabilities and offerings, thereby enhancing our case mix. We are also working to optimise our channel mix by boosting the proportion of overseas, self-pay, and insured patients. Furthermore, we intend to expand our presence in upcountry areas, from where patients frequently visit major cities such as Delhi-NCR and Mumbai for complex procedures. Our patient base spans North India, including Uttar Pradesh, Bihar, Jharkhand, Punjab, Haryana, Rajasthan, and other significant states. To broaden our reach, we intend to enter additional cities or regions and open more outpatient centres to serve local communities better and refer suitable cases to our Network facilities.

Augment Medical Value Travel

Despite competitive healthcare costs, Indias clinical outcomes are comparable to those of developed nations like the US, the UK, and Singapore.

We still rank among the top treatment providers to value-conscious overseas patients in Delhi NCR and intend to grow this market. We serve patients from all over the world, but significant influx is from Iraq, Uzbekistan, Ethiopia, Bangladesh and Turkmenistan. By stepping up our marketing efforts in these areas, we aim to draw in more medical value travellers from key markets such as the Middle East, Africa, Southeast Asia, and the CIS nations. Leveraging our well-known brand, our direct and indirect presence, visits by our clinicians to these nations for outpatient consultations and health camps, and our own or partner representative offices, we intend to attract medical tourists and expand our current patient base.

Further to this strategy, we established company and partner-owned patient assistance centres (PACs) across key markets such as Kenya, Nigeria, the UAE and others. During the year, we established two more company-owned PACs, one each in Nepal and Bangladesh, bringing up the total count to nine company-owned PACs located in nine countries. These PACs guide patients in their journeys, connect them with clinicians of repute over videoconferencing, help them procure and understand treatment plans, advise them in their decision-making, help arrange travel documents, and assist them in seamless transfer to our hospitals. We also focus on contracting institutional patient referrals abroad from government and public sector organisations. We executed a contract with MoH Iraq (Dhi Qar Governorate) and signed similar institutional arrangements with public institutes of Tanzania and Zambia.

Threats

Regulatory challenges

In India, diverse laws and regulations that vary by state govern healthcare. Over the past decade, healthcare costs have risen significantly. As a result, legislative and regulatory proposals have and may continue to control tariff increases, cap margins, and set fixed prices for procedures and diagnostics.

For instance, in February 2024, the Supreme Court of India directed the Department of Health (Government) to set hospital rates, in response to public interest litigation seeking standardization of these rates. It also warned that if the Government doesnt decide on standard rates before the next hearing, interim rates from the Central Government Health Scheme (CGHS) may apply universally. While this directive is under appeal currently, it raised significant concerns among private hospitals regarding its potential impact on hospital revenue and operational viability.

The central government has the authority to regulate prices for essential medicines. It has imposed caps on the prices of four medical devices: cardiac stents, drug-eluting stents, knee implants, and intrauterine devices. The National Pharmaceutical Pricing Authority (NPPA), which is responsible for periodically reviewing and regulating the prices of pharmaceutical formulations and drugs to prevent overcharging and supply shortages, has revised the ceiling prices of over 900 scheduled drug formulations in April 2023.

Such regulatory pricing actions may temporarily affect our Companys operating margins, as we may need to renegotiate with vendors and might experience delays in sourcing these regulated formulations or drugs due to supply chain disruptions.

Financial Pressure

Healthcare financing remains a persistent pain point, characterized by high out-of-pocket expenditures, which historically account for nearly half of healthcare spending. This reliance on out-of-pocket payments, particularly for outpatient treatments, places a heavy financial burden on households and contributes significantly to poverty rates, impacting both rural and urban populations. This may lead to higher bad debts for hospitals and contribute to their operating losses.

Another critical threat stems from hospitals financial strain due to delayed reimbursements from government health insurance schemes. This issue has affected the fiscal health of many healthcare providers, particularly those catering to scheme beneficiaries, necessitating urgent reforms in claims processing and reimbursement timelines under government schemes.

Dependence on Skilled Workforce

The need for more experienced specialised doctors and nursing personnel poses a formidable challenge to the quality and growth potential of Indias healthcare sector. With significantly lower physician and nursing densities compared to global standards, India faces an uphill task in meeting the healthcare needs of its vast population, further exacerbated by regional disparities in healthcare workforce distribution. This shortage may also lead to challenges in finding and retaining skilled healthcare professionals due to high demand and competitive salaries, coupled with the need for ongoing investment in education, training, and professional development for healthcare workers. Addressing these workforce challenges is crucial for maintaining high standards of care and ensuring the sustainability of healthcare systems in India.

III. Financial Performance and Results

During the year, we achieved significant milestones in financial performance. On a consolidated basis, net cash generated from operating activities totalled H 1,122 crore, reflecting robust operational efficiency. A substantial portion, H 561 crore was allocated towards acquiring new hospitals and H 779 crore towards ongoing capacity expansion projects, underscoring our commitment to enhance healthcare infrastructure. Additionally, H 97 crore was distributed to shareholders as dividends, highlighting our dedication to create value for our investors. As of the end of FY24, our net debt stood at H 131 crore.

On a consolidated basis, occupancy rates for FY24 averaged 74%, slightly down from 76% in FY23. The lower occupancy percentage resulted from an increase in the number of operational beds. In absolute terms, occupied bed days increased in FY24 by 7% compared to FY23. Adding 92 beds at Max Shalimar Bagh propelled this growth, demonstrating our strategic approach to capacity expansion and meeting the rising healthcare needs of the society.

Audited Financial Results (Consolidated)

	For the Year Ended March 31, 2024	For the Year Ended March 31, 2023
Income:
Revenue from operations	5,406	4,563
Other income	178	139
Total Income	5,584	4,702
Expenses:
Consumption of drugs, consumables and implants	1,119	937
Increase in inventories of drugs, consumables and implants	(1)	(15)
Employee benefits expense	934	809
Professional and consultancy fee	1,117	986
Other expenses	744	604
Finance costs	60	84
Depreciation and amortization expense	245	232
Total Expenses	4,219	3,638
Net Profit before Tax	1,365	1,064
Total comprehensive income for the year	1,051	1,103
Profit before interest, depreciation and tax	1,670	1,380
PBIDT margin (%)	29.9%	29.3%

FY24 vs. FY23 Consolidated Results

Income

Revenue from Operations: Revenue from operations increased from H 4,563 crore in FY23 to H 5,406 crore in FY24, reflecting a robust growth of approximately 18.5%. Increase was due to higher average revenue per occupied bed (ARPOB) by ~13% and occupied beds by ~7%.

Other Income: Other income rose from H 139 crore in FY23 to H 178 crore in FY24, marking an increase of 27.9%.

Total Income: Consequently, total income increased from H 4,702 crore in FY23 to H 5,584 crore in FY24, a growth of 18.8%.

Expenses

Consumption of Drugs, Consumables and Implants: The expenditure on drugs, consumables, and implants increased from H 922 crore in FY23 to H 1,119 crore in FY24, representing a rise of approximately 21.3%. The increase is in line with the growth in revenues and high-end procedures such as robotics, liver transplants, etc.

Employee Benefits Expenses: The cost associated with employee benefits rose from H 809 crore in FY23 to H 934 crore in FY24, an increase of about 15.5%. Increase partially on account of the addition of new subsidiaries for the relevant period from the date of acquisition; on account of merit increase in salary; higher ESOP expense due to full year impact of ESOP grant in October 2022 and new ESOP grant in March 2023.

Professional and Consultancy Fees: Expenses on professional and consultancy services increased from

H 986 crore in FY23 to H 1,117 crore in FY24, marking a growth of approximately 13.2%. The increase is partially due to adding new subsidiaries for the relevant period from the date of acquisition (mainly deal-related expenses).

Other Expenses: Other expenses went up from H 604 crore in FY23 to H 744 crore in FY24, representing a significant rise of 23.1%. The increase was mainly due to GST expense on variable management fees relating to BLK, an increase in contingent consideration expense due to a change in the discount rate and, accordingly, a change in projections, and higher costs on account of branding, travel, power and utility.

Finance Costs: Finance costs decreased from H 84 crore in FY23 to H 60 crore in FY24, reflecting a reduction of about 28.6%.

Depreciation and Amortisation Expenses:

Depreciation and amortisation expenses increased slightly from H 232 crore in FY23 to H 245 crore in FY24, marking a rise of about 5.5%.

Total Expenses: Overall expenses increased from H 3,638 crore in FY23 to H 4,219 crore in FY24, an increase of approximately 16.0%.

Profit

Net Profit before Tax: The net profit before tax increased from H 1,064 crore in FY23 to H 1,365 crore in FY24, reflecting a growth of about 28.4%.

Total Comprehensive Income: Total comprehensive income for the year increased from H 859 crore in FY23 to H 1,051 crore in FY24, a growth of 22.4%. FY23 total comprehensive income excludes gain on one-time reversal of deferred tax liability of H 244 crore pursuant to voluntary liquidation of a wholly owned subsidiary.

PBIDT

PBIDT: PBIDT increased from H 1,380 crore in FY23 to H 1,670 crore in FY24, an improvement of approximately 21.0%.

PBIDT Margin: The PBIDT margin improved slightly from 29.3% in FY23 to 29.9% in FY24.

Key Financial Ratios (Consolidated)

S. No. Ratio	Numerator	Denominator	March 31, 2024	March 31, 2023	% Variance	Reason for Variance
1 Current Ratio	Current Assets	Current Liabilities	1.37	1.86	-26.48%	Decreased bank FD due to acquisitions (business combinations) during the year
2 Debt-equity Ratio	Total Debt	Shareholders Equity	0.15	0.09	66.15%	Increased due to additional borrowings taken during the year for funding the acquisition deal
3 Debt Service Coverage Ratio	Earnings Available for Debt Service	Total Debt Service	6.26	8.19	-20.75%	Debt service ratio has declined mainly on account of additional debt taken for the purpose of expansion of Nanavati-Max Hospital
4 Return on Equity	Net Profit / (Loss) after Tax	Average Shareholders Equity	13.37	16.12	-17.04%	The accumulated profits/ retained earnings, of Max Healthcare group increased in the current year as compared to last year, hence there is a decline in return on equity ratio

Net debt position (Consolidated)

The gross debt stands at H 1,150 crore as of March 31, 2024, a significant increase from H 565 crore as of March 31, 2023. The rise in FY24 is mainly due to a loan of H 600 crore to fund the Sahara Hospital acquisition and a loan at Max Nanavati for expansion and equipment purchase.

Net debt, which excludes lease liabilities, is calculated by subtracting cash and bank balances from the gross debt. As of March 31, 2024, the net debt is H 131 crore, compared to a net cash position of H 758 crore on March 31, 2023. This transition from a net cash position to a net debt position indicates that we have utilised our cash reserves and potentially increased borrowings to finance our operations and growth initiatives over the year.

H Crore

	March 31, 2024	March 31, 2023
Gross Debt	1,150	565
Put Option Liability	87	150
Gross Debt, including Put Option Liability	1,237	715
Cash and Bank Balance	1,106	1,472
Net debt/ (Net Cash) [excluding Lease Liability]	131	(758)
Amount invested in Capex and Growth Initiatives	1,340	336

IV. Outlook

We are well positioned for future growth, backed by a resilient management team, strong financial performance, strategic expansions, successful M&A activities, and a clear focus on leveraging digital technologies. Our commitment to excellence and innovation ensures our continued success in the dynamic healthcare sector.

Robust performance and efficient capital utilisation:

We achieved a remarkable performance in FY24, with significant free cash flows and a net cash surplus as of March 31, 2024. This performance positions us well for future growth and investments. Additionally, our high return on capital employed (RoCE) of 34.7% in FY24 underscores efficient capital use and strategic investment decisions.

Successful Mergers and Acquisitions (M&A): We have a seamless track record of successful mergers, acquisitions and turnarounds, exemplified by recent acquisitions of Sahara Hospital in Lucknow and Alexis Multi-speciality Hospital in Nagpur. Our strategic approach to M&A ensures integration and enhancement of these facilities, contributing to overall growth of the Network.

Competitive Edge and Deal Pipeline: With limited competitive intensity and a robust deal pipeline, we are well-positioned to continue our growth through strategic acquisitions. We maintain adequate headroom for M&A activities even after accounting for brownfield capex, driven by strong free cash flows and low leverage.

Building a Digital Ecosystem: Leveraging our brand equity, customer loyalty, and extensive data repository, we already have a robust digital ecosystem in place and we intend to continue enhancing it. With this initiative, we aim to enhance patient experience, improve operational efficiency, and drive innovation in our healthcare delivery.

V. Risks and Concerns

Our Company manages various strategic and operational risks through a robust framework overseen by the Board of Directors. This framework identifies, analyses, assesses, mitigates, monitors, and reports risks that could impact our strategic and business objectives. These encompass operational, regulatory, medical, strategic, human resources, and financial risks.

The Risk Management Committee (RMC) is vital in establishing detailed risk management guidelines, including policies, risk appetite guidance, and relevant frameworks. We categorise risks into medical and non-medical categories, with dedicated senior management personnel as risk officers. Regular RMC reviews focus on the risk register, risk heat map, and mitigation plans for high and critical risks. These reviews assess measures for risk mitigation through avoidance, transfer, control, or acceptance strategies.

Our risk management policies and systems undergo periodic reviews to adapt to market conditions, business activities, and evolving risk appetite levels. While no risk poses an existential threat, the Board recognises specific risks such as litigation, fire incidents, and regulatory changes for their potential material impact on our financial performance and reputation.

VI. Internal financial control systems and their adequacy Our Company has a robust and well embedded system of internal controls facilitated through appropriate IT system and workflows, which are reviewed and upgraded based on risk control testing performed from time to time. Comprehensive policies, guidelines and procedures are laid down, reviewed and updated for all business processes and these are accessible to the concerned employees through the designated web page. The internal control system has been designed to ensure that financial and other records are reliable for preparing financial statements, management reporting for business performance management and for maintaining accountability of assets.

An extensive risk-based programme of concurrent audits, internal audits, exceptional reporting and IT based transaction controls, coupled with constant management reviews and dash boarding of data, provide assurance to the Board regarding the adequacy and efficacy of internal controls. The internal audit plan is dynamic and aligned to the business objectives of our Company and is reviewed by the Audit Committee periodically, including the high and medium risk observations emanating from such audits. Further, the Audit Committee also monitors the status of management actions emanating from internal audit reviews. The Internal Audit function and its processes are also subjected to audit by third party experts on periodical basis. During the year under review, above controls were assessed and no reportable material weaknesses in the design or operation were observed. The statutory auditor of our Company did not find any material weakness in controls and / or misstatement resulting from lack of internal controls during the course of their audit.

VII. Material developments in Human Resources At Max Healthcare, we aim to create a professional culture that allows employees to excel in their professions and contribute to our Companys success. We improve our team through initiatives such as learning and development, enhancements to the human resource information system (HRIS) and human resource management system (HRMS), recognition of achievements, and career growth aligned with business needs.

Learning and Development

We are constantly striving to enhance the capabilities and capacities of our talented teams by providing them with platforms to thrive and evolve. Our capability development roadmap includes plans to embed and scale institutional capabilities across the organisation, with commitment from the senior leadership team. Considering various factors such as roles, skills, and reskilling, we aim to ensure the availability of the right workforce to achieve our long-term vision of being Indias most respected healthcare provider. We heavily invest in training and development across the organisation. During the year, we provided approximately two lakh hours of training to our workforce.

We curated customised learning paths based on employee preferences for the Max Talent Development Programme, including the Hospital Operations Programme for Excellence (HOPE), an immersive experiential programme for high-potential leaders aspiring to take up roles in hospital operations, and the Functional Upskilling Programme for Excellence (FUPE), a customised programme for employees aiming to advance in their current roles.

We proactively identify and nurture talented individuals across employee cadres through tailored learning interventions such as Service Excellence Programmes for patient-facing teams, Supervisory Capability Development Programmes for frontline supervisors, Manager Capability Development Programme for people managers, HR Capability Development Programme for eligible HR team members and customised programmes Neev for outsourced team members working in hospitals. In addition to these interventions, we launched the Front Office Transformation Programme and Nursing Transformation Programmes to strengthen the functional competencies of front office and nursing teams by developing functional trainers and focusing on skills-based training within the units.

Reward and Recognitions

The digitisation and standardisation of the Max Healthcare Employee Reward & Recognition (R&R) initiative began with Phase I in November 2022 and progressed to Phase II in January 2024. Before implementation, our workforce of over 19,000 employees, with 70% frontline staff (including partner healthcare facilities), needed a unified experience, while a well-defined R&R framework, standardisation, timeliness, and a transparent recognition culture were lacking.

In Phase I, we partnered with an external provider to digitise our R&R framework, Umang - Pride Within, automating and simplifying the program with a cloud-based solution integrated with our HRMS. The framework covers Spot Awards, Performance Awards, Longevity Awards, WeCan Awards, and Annual Awards. Phase II introduced Umang 2.0 with features like social media sharing of recognition posts, company-wide social recognition, flexible reward point redemption, exclusive perks and discounts, a Hall of Fame, hobby clubs, classifieds, an employee wellness portal, and non-monetary awards.

This initiative boosted a strong culture of appreciation, empowered employees to acknowledge achievements, and streamlined the R&R experience with timely recognition and detailed reporting. We recorded 17,600 employee recognitions in the first year, with 30% uniquely recognised under monetary awards. Advanced features in Umang 2.0 increased recognitions from one nomination every 41 minutes to ten nomination every 60 minutes, with 130,000 recognition points redeemed monthly.

Employee Engagement

At Max Healthcare, we intend to cultivate an environment where every team member feels appreciated, inspired, and supported. Our employee engagement initiatives are comprehensive and impactful, spanning the entire organisation. These include diverse team-building activities, ample opportunities to learn and grow, an efficient R&R programme, regular pulse surveys, numerous connect forums, and moments of celebrations and togetherness. We also provide career advancement opportunities and prioritise employee well-being through various health and wellness programmes. Additionally, our active participation in community service nurtures a sense of purpose and connection beyond the workplace, all contributing to a seamless work-life integration.

Digital HR

Over the last year, our dedication to leveraging the potential of digital innovation has altered our HR procedures and improved the entire employee experience. By integrating new technology and optimising operations, we have increased operational efficiency and created a more connected, compliant, and engaged workforce. Our journey to a fully digital HR ecosystem has revolved around providing a smooth, efficient, and employee-centric experience. The progress weve made this year demonstrates our unrelenting commitment to using technology for continuous development and operational excellence. As we move forward, we aim to investigate new digital solutions that will revolutionise our HR environment and empower our staff. Throughout the year, we implemented the following initiatives:

Launch of Umang 2.0: Enhanced employee benefits and experience through the new R&R platform, resulting in over 11,000 nominations within five months and an increased net promoter score (NPS) of 70.

Exit on Mobile App: Exit tasks can now be initiated and approved on the mobile app, increasing compliance and reducing desktop dependency.

Exit Survey: After approval, an automated exit interview form is initiated and shared with the HR manager and L1 Manager, streamlining the exit process.

Chatbot Jinie Improvisation: The new FAQs include policies on POSH, ABAC, code of conduct, and medical card policies, enhancing the employee experience by answering various queries.

Enhanced Onboarding: The onboarding process was improved with the auto-initiated survey 30 days after joining, which provided feedback to enhance the onboarding experience. Additionally, all HR tasks related to recruitment and onboarding are now available on the mobile app, enhancing candidate experience and compliance.

Performance Activities on Mobile App: The mobile app allows employees to manage performance-related activities, making it easier to set goals, check-in, and conduct performance reviews.

Recruitment: Recruitment tasks can be performed via the mobile app, making it easier to raise and approve SRFs and to facilitate HR tasks. The embedded Disha career portal and QR code-based candidate creation created a pool of over 12,000 candidates, improving the candidate experience and recruiter productivity. Alerts for candidates during shortlisting or rejection before the interview stage improved employer branding and candidate experience. Additionally, employees can refer candidates via the referral feature on the mobile app, enhancing the recruitment process and increasing engagement.

Mood Meter: The Jinie bots Mood Meter feature helps managers understand employee sentiment, aiding in organisational pulse checks.

VIII. Other Details

Medical Technology

The speed and accuracy of diagnosis are essential to successful treatment and better outcomes. Hence, we continue to invest in medical technology and equipment, modernise our hospital facilities to offer quality healthcare to our patients and expand our range of services. Our facilities have contemporary medical technology and equipment, including new-generation surgical devices for minimally invasive surgeries. We focus on obtaining advanced technologies to provide such healthcare services, believing that investment in technology and equipment is critical to our operations. This approach leads to better clinical outcomes, lowers ALOS and attracts skilled clinical talent.

128 Slice GE Maxima CT scan at Max Bathinda:

This advanced imaging modality has revolutionised diagnostic imaging.

Da Vinci Xi Surgical robot at BLK-Max: One of the most advanced technologies in India, these robotic surgeries are the safest and most effective across specialities. They are minimally invasive, resulting in minimal blood loss and faster recovery. We also have this technology at our owned and managed healthcare facilities in Saket, Shalimar Bagh, Vaishali, Mohali, Dehradun and Mumbai, as well as at our partner healthcare facility in Patparganj.

Azurion 5 M20 Philips Cath Lab at Max Vaishali: Powered by ConnectOS, this platform delivers a set of interventional tools for high-standard diverse procedures. The optional ClarityIQ technology supports high-quality imaging for a range of clinical procedures, achieving excellent visibility at low X-ray doses for patients of all sizes.

Tomotherapy Machine-Radixact 9 at Max Shalimar Bagh: Unique helical treatment delivery allows the treatment team to administer the optimal dose of radiation directly to the tumour with high precision, designed to provide excellent long-term cancer control.

Artis ZEE Siemens Cath Lab at Max Mohali: This machine offers a complete range of applications to increase clinical capabilities and ease workflow in interventional cardiology, radiology, and surgery. Artis zee provides the flexibility and confidence needed for routine and complex procedures. We also have this machine at our partner healthcare facilities in Patparganj and Saket.

3T Magnetom Lumina MRI at Max Vaishali: New

3T Open Bore system that enhances productivity, reproducibility, and patient satisfaction. Powered by premium MR technology, MAGNETOM Lumina combines unique BioMatrix technology, the new syngo MR XA software platform, and the exclusive turbo suite to transform care delivery.

Symbia Evo Excel Dual Head Gamma Camera of Siemens installed at Max Vaishali: As a high-resolution SPECT camera, it can detect and display emitted radiation, depicting the function of various organs and enabling early disease detection.

Clinical Research

We are committed to the highest standards of medical and service excellence, patient care, scientific knowledge, and medical research. We have built a fundamental focus on continually strengthening research and academic capabilities to enable scientific discovery, innovation, disease management, and capacity building. We have consciously invested in creating a research ecosystem through civil and IT infrastructure, a culture of collaboration, a regulatory and compliance framework, and dedicated clinician scientists supported by young researchers to drive solutions that improve health outcomes for the Indian population. Over the last 16 years, we have established a well-defined clinical trials unit, a regulatory office (with scientific and ethics committees and accreditation), a biostatistics centre, a grants office, and a scientific research advisory board.

Our core research activities include public health studies, drug and device trials, data research, and incubator accelerator projects. The electronic patient records, supplemented by our clinical data analytics cell and digital health solutions team, have led to data-driven decision support for clinicians, risk identification for proactive care plans, and improved efficiency of healthcare delivery. Our state-of-the-art genomics lab and biorepository further support our efforts. The Masters of Public Health programme, PhD programme, MSc clinical research degree course, multiple workshops, certificate courses, and internship opportunities complement our on-ground research efforts.

During the year, we conducted over 100 clinical trials and initiated 44 new projects across our network facilities. We attracted three international and 19 national grants worth H 4.8 crore from various national and global funding agencies, including the National Institute for Health and Care Research (NIHR) UK, the Indian Council of Medical Research (ICMR), the Department of Biotechnology (DBT), Indian National Science Academy (INSA), Biotechnology Industry Research Assistance Council (BIRAC), Pfizer, and Ashoka University. Our clinicians and academicians produced over 350 publications in high-indexed, peer-reviewed journals. We also published the first edition of our own Max Medical Journal, featuring original articles, review articles, clinical studies, and commentary.

Academics

Max Institute of Medical Education (MIME), our Companys educational arm, is dedicated to training medical and non-medical professionals, allied healthcare staff, corporates, embassies, multinational companies, and other medical institutions across India. During the year, we registered over 9,800 students in various academic programmes. We launched the RCOG MHC obstetrics and gynaecology programme in Delhi and the internal medicine training programme in Mumbai. We run successful PhD programmes in public health/medical research and masters programmes in clinical research, public health, and healthcare quality management. We introduced the advanced trauma life support course by the American College of Surgeons, US, and advanced stroke life support with the American Heart Association and Gordon Centre, US, across India.

Our successful continuing medical education (CME) programs prioritize the needs of our healthcare professionals. We identify skill gaps through needs assessments and then develop engaging and evidence-based content that addresses those gaps. Offering a variety of learning formats, from traditional in-person lectures to online modules and interactive workshops, we cater to different learning styles and schedules.

Nursing Initiatives

During the year, we accomplished notable advancements in nursing practice, leadership development, and patient care driven by strategic initiatives, educational programmes, and quality improvements to enhance nursing competencies and patient outcomes. Key focus areas for the year included leadership development, recruitment and retention, patient satisfaction, continuing education, and innovative practices and technologies. Our nursing satisfaction scores reached 97% in FY24, reflecting our commitment to patient-centred care, communication, empathy, and collaboration.

Quality Improvement

Our nursing quality improvement projects (QIPs) show our commitment to continuous improvement. These initiatives aim to enhance patient care, operational efficiency, and compliance across critical areas. For instance, we reduced hospital-acquired pressure ulcers (HAPI) through training, rigorous risk assessment, and implementing patient repositioning protocols. Efforts to minimise sample rejections improved efficiency and patient satisfaction by identifying and resolving the causes of rejections. We strengthened compliance in billing for blood glucose monitoring through focused training, daily business intelligence reports, and real-time monitoring.

We also prioritise continuously improving nurses emergency life-saving abilities through comprehensive training programmes. Basic life support (BLS) training is mandatory for all new nurses. Within 90 days of joining, nurses undergo advanced life-saving training tailored to their specific areas, including medical emergency life support, paediatric life support, and the neonatal resuscitation programme. Regular training sessions educate nurses on identifying early warning signs of clinical deterioration, ensuring high standards of patient care.

Education and Professional Development

To enhance our nursing staffs skills and ensure high standards of patient care, we implement competency assessments, certification programmes, and standardised training policies. Key initiatives include critical care nursing certification at Max locations, the Sangrakshak infection control course for national and international nurses, and the Virohan nursing induction programme, completed by over 3,900 nurses.

Our training programmes cover various medical areas, including medication management, intravenous (IV) therapy, oncology care, and neurological disorders. They also focus on the National Programme for Health Care of the Elderly by the Ministry of Health and Family Welfare, cervical cancer, antibiotic restriction, wound and stoma care, surgical site infection (SSI) prevention, and vascular access management. Other critical areas addressed include airway management, cardiac procedures, emergency medicine, pain management, clinical alarms, diabetes education, blood culture, neonatal resuscitation, pressure ulcer management, traumatic brain injury, and patient safety.

Nursing Leadership and Recruitment

Our nursing leadership development programmes have bolstered essential skills communication, critical thinking, decision-making, collaboration, and advocacy skills. Training covered healthcare quality, patient safety, technological advancements, operational excellence, and financial principles. The theme of Nurses Day 2023 (Our Nurses, Our Future) emphasised support for nursing practice and education. We introduced nursing clinical instructors to mentor nurses, ensuring high-quality care and improved patient experiences. Effective recruitment strategies included monthly workforce monitoring, targeted advertising, partnerships with nursing schools, incentivised referrals, streamlined hiring, and structured onboarding, with recruitment drives involving campus and online interviews.

Digital transformation

During the year, we generated approximately 22% of our total Network revenues from web-based marketing activities and online appointments, reflecting a robust 52% growth year-on-year. Notably, the year saw over 40,000 video consultations, underscoring our commitment to leverage digital platforms for enhanced patient engagement and operational efficiency. These efforts align with our strategy to deliver innovative healthcare solutions while meeting the evolving needs of our patients.

We have implemented several other digital initiatives to enhance patient care and operational efficiency across facilities. Our patient app, Max MyHealth is available on Android and iOS platforms and allows patients to book appointments (in-hospital and video consultations), pathology services, and Max@Home services across the Max Network of hospitals. We also provide access to comprehensive health records, including bio-marker trends, radiology images, electronic prescriptions, and discharge summaries dating back to 2020. We manage hospital assets through integrated systems like hospital information systems (HISs), electronic medical records (EMRs), and appointment booking systems, ensuring streamlined inpatient and outpatient management, electronic admissions, and patient discharges. IoT-based automation optimises patient transport, equipment movements, sample handling, and pharmacy deliveries.

Environment, Energy and Fire Safety Matters

We lead by example by integrating advanced technology with compassionate healthcare, setting sustainability and patient care benchmarks. Our focus on environmental responsibility and operational efficiency drives us to implement innovative solutions like rooftop solar panels, advanced heating, ventilation and air-conditioning (HVAC) systems, and smart water management practices. Our ongoing efforts in environment, energy, and fire safety showcase our progress towards a greener future while ensuring the highest standards of healthcare excellence.

Recognising the need for enhanced climate control in our in-patient rooms, we installed Wi-Fi-enabled thermostats (Beanbag Cool) that optimise AC settings based on real-time occupancy, resulting in potential monthly savings of H 1,265.3 per fan coil unit (FCU) and a payback period of 8-13 months. Additionally, we installed 400 kWp rooftop solar panels at Max Vaishali, generating 7.6 lakh units of electricity and saving H 31 lakh while reducing carbon dioxide emissions by 541 tonnes by March 2024, underscoring our commitment to sustainable energy practices.

In addition to these specific initiatives, we have implemented comprehensive energy-saving measures across our facilities. These include adopting LED lighting adoption, using variable frequency drives (VFDs) in HVAC systems, and using solar water heating systems, all aimed at reducing energy consumption and enhancing operational efficiency. We also prioritise water conservation through strategies such as the reuse of STP-treated water, rainwater harvesting, and implementing dual plumbing lines to minimise freshwater usage. These efforts support environmental sustainability and align with our commitment to responsible stewardship of natural resources.