Sharad Pandit on how specialist-led operations, integrated diagnostics and disciplined experimentation can make emergency medicine more efficient and more humane
Sharad Pandit has worked across healthcare systems in India, Germany, the United States and Australia, training in paediatrics, emergency medicine, neonatology and intensive care medicine. That experience shaped his view that emergency departments do not have to be organised around the traditional sequence in which patients wait, see a junior doctor, undergo tests and eventually reach the senior decision maker.
In 2011, after years in Australia’s public health system, Sharad helped establish CARE 24-7 as a specialist-led alternative. The proposition was straightforward but operationally demanding: patients should be seen quickly by an emergency specialist, decisions should be made earlier, and the service should be available around the clock. The model has grown across several sites, but its larger significance lies in the questions it raises about how established services can be redesigned without losing clinical accountability or economic discipline.
Put the decision maker closer to the patient
Sharad’s criticism of the traditional emergency department is not that its clinicians lack commitment. It is that the operating structure can create unnecessary distance between the patient and the person ultimately responsible for deciding what happens next. In a large public emergency department, a patient may first be assessed by a young or inexperienced doctor, then move through several layers before reaching the senior clinician who makes the final decision.
That sequence can take several hours, and information can be lost as the case moves through the system. In emergency medicine, Sharad believes, delays and misunderstandings can have serious consequences for patients and their families, particularly when a diagnosis is missed or a deterioration is not recognised quickly enough.
CARE 24-7 was designed around a different proposition. The patient is seen by a specialist at the beginning of the process, allowing tests to be organised sooner and clinical decisions to be made closer to the point of arrival. Sharad reports average waiting times of roughly 20 minutes to an hour across the organisation, compared with the much longer waits that can occur in the public system.
The operating results provide a practical test of the model. Sharad describes a high-functioning emergency department as one that sees more than 1,200 to 1,300 patients per bed each year. One of CARE 24-7’s sites sees approximately 1,400 to 1,500 patients per bed, while other sites operate at lower levels and remain the focus of further improvement. The point is not that one metric captures the whole quality of care, but that clinical design and operational performance can reinforce one another when the service is built around timely decision making.
Outsourcing can change the economics of emergency care
Emergency departments are complex operating environments because they bring together patients and families, emergency physicians, specialists, ambulances, hospitals, government and Medicare. The department must be available continuously, coordinate multiple professional groups and absorb unpredictable demand, while also supporting the hospital’s broader flow of medical, surgical, orthopaedic and urological admissions.
For hospitals, Sharad sees an outsourced model as a way to reduce both financial exposure and operational risk. A department of the size operated in Adelaide may require approximately $7 million to $8 million in upfront costs before the first patient is seen, largely because doctors represent the largest and most expensive workforce. Under CARE 24-7’s arrangement, the organisation pays the hospital rent to operate the service, while the hospital avoids carrying the full fixed-cost burden of staffing and managing the department.
The arrangement also creates a clearer allocation of responsibility. CARE 24-7 holds the contract and employs the doctors, meaning that operational and professional risks associated with the service sit with the provider rather than being absorbed entirely by the hospital. Sharad also points to the flexibility created by the contract: if the service does not perform, the hospital can change providers rather than having to rebuild its own operating model from scratch.
This structure gives hospitals more than a cost-saving mechanism. An efficient emergency department affects the hospital’s reputation, patient experience and ability to generate admissions, while an underperforming department can damage all three. The provider therefore has to demonstrate that specialist staffing and around-the-clock availability produce better performance, rather than simply offering a different ownership arrangement.
Patient expectations are moving faster than the system
Sharad sees patient behaviour changing as people gain more access to health information through the internet and emerging AI tools. Patients may arrive with a stronger understanding, or at least a stronger perception, of what is wrong with them, and they increasingly expect to be seen quickly by someone who appears to care about their situation.
That expectation is becoming more difficult to meet as populations age and patients present with multiple, interconnected problems. Emergency care must often be efficient, compassionate and expert at the same time, because a complex case cannot be reduced to speed alone. Sharad believes some patients are willing to pay for that combination when the public system cannot provide it consistently.
Urgent care centres form part of this changing market, although Sharad does not see them as interchangeable with specialist emergency departments. Many lower-acuity cases can be treated in urgent care, but problems such as complex lacerations, hip dislocations or acute arrhythmias requiring electrical cardioversion may require the skills and facilities of an emergency specialist.
The opportunity is not simply to compete for the same patients. It is to create clearer pathways between levels of care. CARE 24-7 is exploring whether patients with non-emergency but time-sensitive problems could be referred into a single facility where consultations, imaging, pathology and diagnosis are organised on the same day, rather than being spread across a general practitioner, external testing providers and later specialist appointments.
Sharad describes the existing pathway as vulnerable to delay at every stage. A patient may wait for a general practitioner appointment, then wait for tests, then wait for the results and a further consultation, allowing several days or even a week to pass between the onset of symptoms and a diagnosis. Bringing the elements together could reduce inefficiency and, in some cases, prevent the consequences of a critical diagnosis being missed.
Technology matters when it removes friction from the care pathway
Sharad does not describe technology as a substitute for clinical judgement. He sees it as an enabler of scale and as a practical means of removing delays that clinicians and patients currently have to tolerate.
One example is the difficulty of retrieving tests performed at external facilities. A patient may arrive in the evening with radiology or pathology completed elsewhere, but the originating facility may already be closed or difficult to access. CARE 24-7 is exploring a system that would allow clinicians to retrieve imaging and other test results through a single sign-on, regardless of where the work was performed.
The organisation has also used dictation technology to improve documentation. Sharad describes himself as a poor and expensive typist, while doctors using dictation software can have their notes transcribed directly into the patient chart. He estimates that the change has improved physician efficiency by approximately 25% to 30%, illustrating how relatively modest technology investments can produce meaningful operational gains.
Other possibilities remain exploratory. Provider-led triage has been introduced to reduce the time patients spend waiting for a decision, while virtual consultations before arrival could gather a patient’s history and help determine the appropriate pathway. Sharad is also considering whether an AI agent could collect information before the patient reaches the department, although he presents this as an area for investigation rather than a completed solution.
The broader opportunity is to connect diagnostics, patient transport, admission pathways and after-hours care more intelligently. For Sharad, technology is most useful when it helps the organisation orchestrate those elements as one system rather than adding another isolated tool to an already fragmented process.
Scale the operating model, not only the physical sites
Sharad wants CARE 24-7 to grow because he believes the model can create value beyond its current footprint. He is also clear that growth cannot mean simply adding emergency departments. The existing sites must remain efficient, and expansion must improve the service rather than multiply an imperfect version of it.
Workforce capacity is one of the largest constraints. Specialist emergency physicians are difficult to recruit and manage, so CARE 24-7 has explored international recruitment and has doctors from the United Kingdom working with the organisation. Without a reliable workforce model, the economics and clinical promise of expansion remain theoretical.
The company’s experience also suggests that the most scalable asset may not be the physical emergency department. Its accumulated knowledge includes specialist staffing, rostering, clinical governance, patient flow, diagnostics, training and the coordination of hospital relationships. Those capabilities could potentially be offered in modular forms to hospitals that are not ready to transfer full responsibility for their emergency operations.
Sharad acknowledges that this approach would require moving beyond relationships as the primary basis for winning contracts. CARE 24-7 benefits from established relationships with hospital groups and from being an incumbent provider that has demonstrated performance. A more portable model would need to communicate its value through credible metrics such as utilisation, waiting times, efficiency and patient-flow outcomes, while still recognising that relationships remain important in business-to-business healthcare.
He is also considering subscription-based access to emergency services, in which families pay a fixed monthly fee. Such a model could offer a more comprehensive service while reducing pressure on the public system, although its viability remains under exploration. The same principle applies to public-private partnerships, where a private organisation could operate a public emergency department while being held accountable for the care delivered.
Adapt without becoming attached to the existing method
Sharad believes CARE 24-7 occupies a useful strategic position: it has established clinical credibility and hospital relationships, but remains small enough to question conventional practice. That position makes it possible to examine whether every patient needs to enter the traditional emergency department pathway, or whether lower-acuity cases can be separated and managed through a different route before escalation becomes necessary.
His approach to innovation is deliberately practical. He describes a principle from his upbringing in India that emphasises commitment to purposeful action, learning from results without attachment to the existing method and adapting the next action accordingly. For an organisation operating in a tightly regulated, high-risk environment, that discipline is more useful than innovation for its own sake.
The same mindset informs Sharad’s interest in studying other institutions that have created integrated urgent-care models at significant scale. He plans to examine how a charitable medical institution in southern India manages large volumes of patients who need urgent attention but not necessarily emergency treatment, with the intention of bringing relevant lessons back to Australia.
His ambition is ultimately framed by three ideas: community, responsibility and opportunity. The challenge for CARE 24-7 is to combine those commitments with a model that can recruit enough specialists, maintain clinical standards, demonstrate operational value and expand beyond a handful of sites. That requires treating the organisation’s methods as something to be tested and improved, rather than as a finished formula.
Sharad’s experience suggests that established healthcare systems can be challenged without dismissing their purpose or the people working within them. The more productive approach is to identify where the current design creates delay, cost or avoidable risk, then rebuild the relevant parts around the patient, the decision maker and the resources required to deliver both safely and efficiently.
For senior leaders, the lesson is less about copying CARE 24-7 than about recognising where the real value of an operating model resides. It may sit in the coordination of people, information and decisions rather than in the physical assets through which the service is delivered. Organisations that can preserve their clinical or operational credibility while remaining willing to adapt their methods will be better placed to extend that value into new partnerships, new pathways and, potentially, new business models.
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