In India’s quest for becoming a more
vibrant and more robust society, healthcare plays a very important role, along
with all other aspects of social infrastructure like education, housing, nutrition,
water, and sanitation. In the important field of healthcare, hospitals have a
great role to play. The General Hospitals and the Railway Hospitals established
and run by the Central & State Governments and the Indian Railways
respectively, and the dedicated hospitals established and run by certain large
industrial townships and leading business houses have served as the backbone of
Indian hospital infrastructure. The entry of private sector into medical care
in the post-independent India initiated a significant change in the country’s
hospital system. P D Hinduja Hospital
established in the early 1950s in Mumbai by late Shri P D Hinduja, the
visionary patriarch of the Hinduja Family is a pioneering example of how
business entrepreneurship can transform healthcare in India. The transformation
in healthcare standards brought in by the private initiative concept has been
significant. Subsequent decades have seen the important trend of medical
professionals turning entrepreneurs in the healthcare sector through corporatization
route in India.
One of the important benefits of
corporate hospitals has been the institutionalization of a national hospitals-chain
concept. Apollo Hospitals established by the physician-visionary Dr Prathap C
Reddy in Chennai is a shining example of what corporate hospitals can achieve. Starting
with the first hospital in Chennai in the early 1980s, Apollo has grown rapidly
in Chennai as well as across India. Fortis Hospitals, Wockhardt Hospitals and a
few other such chain initiatives in more specialized areas like eye care and
dental care are clear examples that the corporate imperative of growth drives
the creation of a large modern hospital infrastructure that could benefit the
society. Governments have also become cognizant of how a combination of scale,
scope, modern technology and best medical practices constitute both the drive
and result of corporate hospitals. The new NDA Government has, for example,
taken up establishment of more All India Institutes of Medical Sciences (AIIMSs)
as an important driver for social equity in different states. What has been
accomplished, both in public and private sectors, so far is but a fraction of
what needs to be done in India.
Medicine and Management
These developments have brought to
the fore, the importance of management in the growth of hospital chains. As
long as hospitals remained as location-specific ventures run within the State
budgets or specific corporate contributions, the challenges and opportunities
of management tended to be loaded in favour of medicine rather than management.
As commercial and business interests started to fuse with the welfare interests
in a corporate setting, management is seen to be as important as medicine in
enabling growth of hospitals. There are
no preset limits for growth nor are there any restraints on corporate entry.
The four pillars of successful hospitals, namely scale, scope, technology and
practices become the four pillars of successful hospital management. The
success in each and together, however, rests on people.
The variety of talent that is
required to run a modern hospital is simply amazing. From interns and
assistants to specialists and super-specialists, and from nursing and
paramedical staff to engineering and technology professionals, the expertise
that is required is varied. Today’s hospitals are an embodiment of technology
as much as of medical practice. Expertise with equipment has become a dominant
need, bringing with it a concomitant need for superior medical and surgical
support practices. This has not only resulted in better diagnostics and
treatment but also brought out the need for generating adequate returns on
investment for viability and reinvestment.
The net consequence is that a modern hospital is a 24X7 operation,
evident as a beehive of intense activity during the daytime, and as an
institution that never sleeps even in the nighttime.
Personalized Science
A hospital is like no other
institutional activity (not even like education which is commonly seen as the
most individualized institutional activity) not only because the biology of
each individual varies but also because wellness is a combination of the body
and mind. Surely, there is a great degree of standardization in terms of
disease causative organisms and disease curing pharmaceuticals but each
individual (and individual’s) case of disease and its treatment. Unlike in a
factory or laboratory setting where each good process produces a good result
and a bad process leads to a bad result, in a hospital setting a good process
may not always assure a good result while a bad result will surely lead to
life-threatening outcomes. This is because the individual cause and response
mechanisms vary significantly. A hospital, unlike any other business or
industrial setting, converts an intrinsically “bad” (diseased) “product”
(patient) into a “good product” (cured patient).
Further complexity arises because a
cured patient still needs days and weeks if not months to become a fully
recovered individual. This means that even outside the hospital’s confines, the
hospital needs to exert a positive influence through motivation for, and
engagement with, the patient. In doing so, the hospital needs to be sensitive
to the living environment of the patient and be concerned about the caregivers
(and stress givers too!). A standardized and holistic treatment paradigm is,
therefore, a major challenge. The way the challenge can be met is only through
pooling of knowledge on patients, practices and outcomes. To address the
complexity of personalized science that true medicine is, a factory-style
commercially run hospital would have few solutions except continuous employee
engagement. In a 24X7 operational environment where every participant is fully
stretched and specializations are tightly defined, the time and space to engage
employees is severely limited.
Employee Engagement
Employee engagement has multiple
connotations. Many, including experts, define engagement in terms of
initiatives and activities such as on-site and off-site learning and
development initiatives, group sports, celebration times and recognition
initiatives. This is probably in tune with the philosophy that individuals in
organizations are well covered on-the-job as to the ‘know how’ and ‘know why’ aspects,
and they need to be developed only in terms of personality and interpersonal
skills. Employee engagement has, however, a perspective beyond competencies and
attributes of members and teams. Employee engagement is both a process and
outcome; the process seeks to develop and sustain oneness between the
employee(s) and the organization, with oneness being the outcome. Employee
engagement would be a cluster of initiatives emphasizing the larger purpose of
the organization and its employees. It demonstrates how the work of each and
every employee contributes to the larger purpose.
In the case of an automobile firm,
each employee is engaged to appreciate how his or her work contributes to
making the automobile more efficient, more economical, more elegant and safer
for the user. For a pharmaceutical firm, the employee is engaged to appreciate
how the medicines developed and manufactured by his or her firm are critical to
healthcare and patients. In a design firm, the employee is engaged to
appreciate how his or her designs help consumers meet new functionalities with
greater lifetime value. For a hospital, employee engagement is all about diagnosis
and treatment of disease and making patients healthy. Firms typically resort to
multiple staff get-togethers, with adequate time and space, to promote employee
engagement. However, unlike such firms, hospitals which work round the clock in
confined spaces find it difficult to disengage their staff for even short
lengths of time and in any extent of space.
Engagement at Apollo
Ever since its inception in 1983,
Apollo Hospitals has set up a scorching pace of growth. According to Apollo Website,
in just over 3 decades, Apollo’s presence grew to encompass over 10,000 beds
across 64 hospitals, more than 2200 pharmacies, over 100 primary care and
diagnostic clinics, 115 telemedicine units across 9 countries, health insurance
services, global projects consultancy, 15 academic institutions and a Research
Foundation with a focus on global clinical trials, epidemiological studies,
stem-cell and genetic research. Each of the facilities is marked by a seemingly
endless flow of trusting patients keeping all of its facilities and expert and
support staff fully stretched. Chronic hyper-demand and consequent acute under-capacity
leaves no time for anyone to be on any special engagement efforts, either in
terms of time and space. Yet, Apollo happens to be at the forefront of medical
technology and practice, providing world class healthcare at fractional
costs. The model of employee engagement
at Apollo, that is effective despite the constraints, is unique. It is a
combination of living entrepreneurship, visible leadership, state-of-the-art
technology, patient-centric business model and sustainable brand equity.
Fundamentally, the Founder-Chairman,
Dr Prathap C Reddy continues to be a highly visible leader even as the hospital
network focuses on the strides made by him under his astute leadership. He has
retained, to date, his office in the hospital premises, preferring the bustle
of teeming patients to the solitude that an independent office tower may offer.
Secondly, the hospital organizes highly visible campaigns within the hospital
premises; the recent green tree show recognizing the families of organ donors
and raising awareness about the virtues and benefits of organization is one
example. Dr Reddy takes part in all such campaigns, reinforcing leadership
visibility. Thirdly, Apollo pioneered a system of highly competent and creative
surgeons and physicians developing their own teams of medical excellence. The institute
for cardio-thoracic surgery under the care and leadership of Dr M R Girinath,
Chief Cardiovascular Surgeon at Apollo Hospitals Chennai is a great example.
Specialized institutes were progressively set up under the leadership of
various physicians and surgeons of repute. Fourthly, Apollo established schools
of nursing to train nurses to the requisite standards, and to provide the
needed talent pool given the shortage of qualified and trained nurses. Fifthly,
Dr Reddy pioneered the integration of the latest technologies as they became
available, from PET Scans and fMRIs to Radio Knifes and Robotic Surgeries.
Bonded by Nobility
Employee engagement in hospitals should
not merely be a process of managements engaging with employees. Effective
employee engagement in hospitals needs to be a highly visible process of
employees inspired to engage themselves in patient care. Engagement develops
with an appreciation of how complex and challenging, and yet how satisfying,
the process of scientific, empathetic and compassionate patient care is. As
individual experts treat complex cases, they need to be showcased not merely to
build the hospital’s brand equity but more importantly to increase the
confidence levels of patients and to inspire its medical experts and technical
staff to seek higher accomplishments. Apart from introducing high technology
equipment, information technology needs to be employed to automate patient
medical records and transactions, facilitating data integrity with faster
turnaround. As hospitals fight infections, avoidance of contamination and
assurance of sterility becomes paramount; in this, every employee from janitors,
ward boys and caterers to nurses, doctors and theatre staff have a critical
role. Unlike any other industry, hospitals deal in microbes and viruses as well
as biological and medical waste even as they seek to rid patients of these
harmful marauders and toxins. Environment, Safety and Health needs to be a high
visibility and high impact division in hospitals.
Continuing medical education for all
employees at all levels is the core of employee engagement. Periodic public
interest campaigns to enhance medical awareness (like the MIOT campaign in the
print media on different types of cancers) provide the essential connect
between the society and the hospitals. Emergency and Ambulance Services are yet
another component where saving the lives stays at the centre and core of all
employees. Home health services and telemedicine could provide a cost-effective
holistic wellness paradigm based on prevention as well as rehabilitation and
recovery. That employee engagement transcends the boundaries of individual
hospitals but encompasses a network of different hospitals, law and order
departments as well as general public across cities is illustrated by how organ
donations and transplants are performed through networked professionals and green
corridors. A life saved is a life given to an individual; a patient cured is a
gift to a family and the society; and a disease prevented is a contribution to the
humanity. Employee engagement founded on these principles is a noble
fulfillment that converts the scientific, operational and business challenges
of high quality, affordable and compassionate medical care into a noble
opportunity of employee self-actualization and socio-economic development.
Posted by Dr CB Rao on August 23, 2015