Closer to home.
Connected to expertise.

The journey between visits

Consider an illustrative patient from a small town who needs specialist ear care. The first consultation may require travel, time away from work and a family member to accompany them. Tests may happen elsewhere. A second journey may be needed to discuss the results, followed by further visits for treatment and recovery. No single consultation necessarily fails, yet the overall journey can remain difficult to navigate. This example is hypothetical, not a report of an individual patient.

For a surgeon, the procedure is a clearly defined event. For the patient, care begins much earlier and continues afterwards. A useful service model must therefore account for the decisions, journeys and conversations between clinical encounters. The question is where each part of care can be delivered appropriately, and who remains responsible when the location changes.

A hub-and-spoke network offers one way to organise this work: a central specialist facility connects with local centres that provide a defined range of services. The published organisational model describes a main facility supported by smaller sites, with more intensive care concentrated at the hub. [1] Applying that structure to ENT requires more than a shared name or a visiting clinic timetable.

A regional perspective from Hisar

Santosh Advanced ENT Healthcare provides a concrete setting in which to examine this approach. Its website describes a Hisar surgical hub, local ENT and hearing-care centres at different stages of development, and peripheral clinics. [4–6] The account below distinguishes these published service descriptions from the governance and evaluation arrangements proposed in this article. It is a developing service case study, not an outcomes audit.

Santosh at a glance

A mixed network needs visible status labels. An open hospital, a weekly clinic and an announced centre are different service commitments. Figure 1 captures what Santosh publishes about its network on 25 October 2026. [4–6]

An active hub with phased local expansion

The hub is on Jindal Hospital Road in Model Town, Hisar. The centres page lists Barwala, Siwani and Narwana as weekly ENT OPD locations and Agroha as planned. [4] The Civil Hospital-area centre is announced for 15 November 2026; its page names Dr Harshwardhan and Dr Ayush and describes clinic-day consultations alongside video-supported access between visits. [5] The Hansi centre, opposite the Bus Stand, is marked coming soon and names Dr Parmod Jangra. [6]

The capabilities behind the network

The hospital website describes ENT, head-and-neck, skull-base, otology, rhinology, airway and cochlear-implant care, alongside maxillofacial and medical support. [7] These services give the hub a broader function than receiving referrals: it can coordinate complex decisions and the treatment episode, while local care is organised around a defined scope.

A team that carries the care plan

The doctors page lists Dr Bhushan Kathuria, Dr Parmod Jangra, Dr Harshwardhan and Dr Ayush in the ENT team. It identifies Dr Parmod Jangra as programme coordinator and also lists maxillofacial, physician and nephrology support. [9] A practical network plan should translate this published team structure into a named receiving clinician, named cover and a reliable contact route for each local site.

The hearing-care pathway is especially relevant to local continuity: the website connects assessment and technology with ENT review and rehabilitation. [8] The opportunity is to make those links reliable in day-to-day practice, then measure whether patients complete the intended sequence.

A network with clear responsibilities

The hub and the local centres have different functions, but both need clinical ownership. A local centre should be a place where patients receive useful care within an explicitly agreed scope. The hub should provide the additional expertise and infrastructure that cannot reasonably be available at every location. Neither designation alone establishes what a facility is equipped to do.

Define scope before opening a clinic

A service agreement should specify the staff present, equipment available, investigations offered, procedures permitted and arrangements when the regular clinician is absent. Diagnostic services need appropriate quality assurance. Marketing material should describe what is actually available at that site, rather than list every service provided anywhere in the wider network.

The first planning exercise is a capability map. For each proposed service, identify the responsible professional, supporting infrastructure, referral destination and follow-up arrangements. Expand the scope only when those elements are ready.

Make the referral a completed handover

Giving a patient an address is only the beginning of a referral. In the proposed model, the local team records why specialist input is needed, the urgency assessed by the clinician, relevant findings, investigations already completed and the clinical question to be answered. A named receiving service acknowledges the referral and communicates the next step.

The coordinator then tracks whether the appointment was arranged and attended. If a patient cannot attend, the reason matters: cost, travel, misunderstanding or a change in symptoms may require different responses. Clinical concerns must return to a clinician; administrative staff should not independently downgrade urgency or provide reassurance beyond their role.

After specialist assessment or treatment, the hub returns a concise plan: what was found, what was done, which results remain pending, who will review them, the next appointment and how concerns should be escalated. The clinician requesting or undertaking an investigation should ensure that responsibility for reviewing its result is explicitly assigned. A referral should not vanish into a gap between two organisations.

This emphasis on relationships and coordination across care settings is consistent with the WHO practice brief on continuity and coordination of care. [2] The operational steps proposed here translate that broad principle into a small ENT network; they have not been validated as a local performance standard.

Plan the return journey at the start

When clinically suitable, selected follow-up may take place locally under an agreed plan. This decision depends on the patient’s condition, the treatment provided, local competence and access to specialist reassessment. Some patients will continue to need review at the hub. Convenience must not determine the level of care when clinical requirements point elsewhere.

Consider a second hypothetical example: an adult assessed locally for hearing difficulty. The pathway may include specialist assessment, audiological evaluation, counselling and rehabilitation, according to findings. If ongoing support can be delivered locally, the plan should identify who provides it and how changes are reviewed. Hearing care should be considered across the care journey, consistent with the integrated approach described in the WHO World report on hearing. [3]

Keep an emergency route outside the timetable

A weekly specialist visit cannot serve as the response to every problem. Each site needs a locally approved escalation process, a clear account of its immediate capabilities, and access to the nearest appropriate emergency service. The network must never require a patient to wait for its own hub when another service can provide necessary care sooner. Condition-specific triage criteria belong in separately approved clinical protocols.

Shared standards make the network credible

The local team must be able to contact the specialist team, and the specialist team must be able to trust the information received. Shared documentation, case discussions and supervision can support this relationship. Training should match each professional’s permitted role and should be accompanied by competency assessment where relevant. Attendance at a teaching session alone does not establish readiness to perform a procedure.

GeNext MedEd Foundation could support the educational component through case-based learning, orientation resources and structured reflection. That is a proposed academic role. Clinical responsibility, employment, service contracts and patient records should remain explicitly assigned to the relevant healthcare providers. An academic association does not replace clinical governance.

Use records to preserve continuity

The starting point need not be an elaborate application. It must be a reliable record of the clinical question, action taken and next responsibility. A shared digital system can support that process where appropriately implemented; a structured secure handover can do so when systems are separate. Access should be limited to authorised staff, with appropriate consent, safeguards and a process for correcting errors. Patients need access to an understandable summary of their care.

Technology should make missing follow-up visible. It should not create a second, incomplete record that clinicians must reconcile at every visit. Before adding functions, test whether the team can reliably find the latest plan, pending results and next appointment.

Build sustainability into the service design

A local clinic has recurring costs even when it sees few patients. Staffing, equipment maintenance, premises, consumables, transport and coordination all need to be considered. The proposed business model should account for the whole pathway, including follow-up and rehabilitation, rather than depend only on procedures at the hub. This article makes no claim about profitability or savings.

Patients should receive understandable information about consultation fees, expected investigations and the likely costs of subsequent care. Referral choices should follow clinical need and patient preference. Commercial agreements should not reward unnecessary tests, procedures or movement into the network. A partner who provides good local care should be recognised for that contribution, including when no referral is needed.

Recognise where the model can fail

The hub can become overloaded. Local staff may be left without timely advice. Patients may repeat tests because records do not travel. A network built around one surgeon may become fragile during absence. Each of these possibilities should have a practical response: capacity limits, named cover, agreed response arrangements and review of incomplete handovers. Expansion should follow evidence that the existing pathway works reliably.

Start small and measure the whole journey

A sensible pilot would begin with one local partner, a limited service scope and a named hub team. Before the first appointment, both teams should agree how referrals are accepted, how urgent concerns are escalated, how records move and who follows up missed visits and pending results. The pilot should test those arrangements before additional centres are added.

A short review meeting can examine a sample of completed and incomplete journeys. The purpose is to find where responsibility or communication became unclear. Patient feedback should be collected from people who completed care and, where feasible, those who could not. A busy clinic is not, by itself, evidence of a connected service.

These are proposed evaluation measures, not reported results. The team should define denominators, time periods and data sources before collecting them. Any later claim of improvement should distinguish measured change from changes in case mix, service volume or patient selection.

The promise to the patient

The value of a hub-and-spoke service lies in whether a patient can move through care with confidence: knowing why a referral is needed, what will happen next and whom to contact afterwards. For a regional ENT service, that is the standard worth building towards. Expertise can be concentrated in one place while responsibility for continuity is shared across the entire journey.

Sources and publication notes

Sources 4–9 describe Santosh’s published services and plans as accessed on 25 October 2026. They are institutional self-reports. The proposals for referral tracking, shared accountability and evaluation are the author’s service-design recommendations.

References

1. Elrod JK, Fortenberry JL Jr. The hub-and-spoke organization design: an avenue for serving patients well. BMC Health Serv Res. 2017;17(Suppl 1):457. doi:10.1186/s12913-017-2341-x. https://pubmed.ncbi.nlm.nih.gov/28722550/

2. World Health Organization. Continuity and coordination of care: a practice brief to support implementation of the WHO Framework on integrated people-centred health services. Geneva: WHO; 2018. https://www.who.int/publications/i/item/9789241514033

3. World Health Organization. World report on hearing. Geneva: WHO; 2021. https://www.who.int/publications/i/item/9789240020481

4. Santosh Advanced ENT Healthcare. Centres. https://www.santoshadvanceenthealthcare.com/our-centres

5. Santosh Advanced ENT Healthcare. Santosh ENT & Hearing Care Centre, Hisar. https://www.santoshadvanceenthealthcare.com/hisar-satellite-centre

6. Santosh Advanced ENT Healthcare. Santosh ENT & Hearing Care Centre, Hansi. https://www.santoshadvanceenthealthcare.com/hansi-centre

7. Santosh Advanced ENT Healthcare. Hospital information. https://www.santoshadvanceenthealthcare.com/hospital

8. Santosh Advanced ENT Healthcare. Audiology, hearing and speech. https://www.santoshadvanceenthealthcare.com/audiology-hearing-speech

9. Santosh Advanced ENT Healthcare. Doctors and clinical team. https://www.santoshadvanceenthealthcare.com/fresh-team

Publication details

Dr Bhushan Kathuria is associated with Santosh Advanced ENT Healthcare and GeNext MedEd Foundation. This educational service perspective uses institutional website descriptions and proposes a framework for development. It presents no patient-level data or audited outcomes and makes no claim of independent peer review. Text preparation and original diagrams were assisted by AI.