Where should a big hospital be run from?

Hospital is a contingency business. I mean, the consumer of a hospital is always in trouble. And 'what's the need' is a forgone question, though of course needs careful consideration.

How do we behave when in immediate trouble, emergency or dire need?

Unfortunately, a lot of hospitals took a leaf from the general assembly line management system and got it all wrong. (When I say that, I am aware of certain hospital which used assembly line management to great effect.) Yes, the ones who got it wrong are the ones who made secluded chambers for managers responsible to take care of the operations. They made nodes which would be far from where the consumer(patient) would typically rush in. They made the team wait at these nodes where the consumer(patient) would typically find it difficult to reach.

Unlike a grand monumental atrium-like central empty space available at different places to make the visitor feel good, a hospital has to have the pilot and his entire team right where the consumer first walks in. Yes, right at the first touch-point. Empty spaces help the movement but slowly kill the guy in pain.

Egos would not let the above happen. Perhaps then, the most responsible person who's supposedly called the COO and his entire team meant to deliver care, has to be right where this patient walks in. Mind you, not just that one person. His entire care-team.

And then see if a hospital is any less enjoyable and any more difficult to manage than other places.

Doctors as clients

Doctors will always be needed. Never will doctors not be a 'need'. Indispensable they are. This indispensability (and the 'life-saving' aspect of it) makes people view doctors as noble.

But the few doctors I've consulted and talked with makes me infer that it is this very 'indispensability' that fills them with hubris. Let me list down the elements of this hubris:

• I deserve everything
• I know everything
• I can buy everything
• I can manage everything

Unfortunately, these are some diseases suffered by a lot of people. Perhaps most, at one or the other time. The only thing is, lesser mortals realize it very often and sort it out within themselves. But with doctors, it could be tough; for they see themselves as ones who treat others and, therefore, ones who are beyond treatment (Godly wouldn't be wrong!).

Anyway, I wonder if the misconceptions stem from the fact that medical practice relies so much on memory and dexterity of hands; reading people's minds and mapping their ways of thinking and behaving is something else. In that, doctors aren't faring any better, if not worse.

Crabs vs Elephants update

Attended by 52 doctors of Bhilwara.

Appreciated by (almost) all of them.

Made sense to (almost) all of them.

The presentation and talk went on for about 45 minutes followed by a discussion of about 30 minutes. And of course more discussions ensued with dinner.

How and when the spark turns into fire is yet to be seen. :)

Crabs vs Elephants

Invitation Cards for the Conference

That's the title of the conference on Medical Business Economics arranged here tonite at 8:00. About 100 odd doctors are expected to participate. Hoping for a breakthrough.

On platforms of execution

If 'execution' demands a platform, what is that platform made of? People, their attitude, their thinking abilities, their education, their knowledge, their ambitions, etc.

Looked at in that context, Mumbai is a terrific platform. Seen broadly, you'll find similarities in attitudes, in education levels, in willingness to do stuff, in ambitions, etc. Just to give an example, there are countless MBAs from top b-schools in Mumbai. Just this very fact ensures that there is a certain level of thinking - which is needed for good work - already in place. It isn't a surprise that so much work happens there.

Bhilwara is another platform. One where there are such large inconsistencies in education levels, in ambitions, in attitudes, in thinking abilities, etc. How can a team ever work well to execute anything of substance?

So then the challenge of working in such a place is twofold. First, manage to create a platform. Then worry about execution.

Converting 'expert practice' into 'labour'

That term 'labour' sounds demeaning, condescending. It seems to me though that's the route to one of the biggest challenges faced by entrepreneurs: scalability.

Working at the hospital in Bhilwara has made me realize that firstly getting good (by 'good', I mean 'thinking') talent to get things done is tough. Even if the guys are willing, somehow they fall short when it comes to skills.

Making people skillful is definitely a long term task. So is helping them think well at an individual level. Perhaps they might think well as a group. But to work in a group requires appreciation and respect of other people to some degree. Out here all are kings!

So?

Perhaps making the same burger over and over again is tough. So the right man at McDonald's turned it into a series of such simple steps that employees don't have to put their mind to making a right burger. They simply undertake a few mechanical steps (even when they are numb) and churn out right burgers. Now since they churn out the burgers which are relished by people all over the world, do we call them 'burger making experts'? It's labour.

On an car manufacturing assembly line, engineers put the parts together and churn out cars? Are they 'car making experts'?

Indeed, the other word made popular for such arrangements is 'process'. Process repeated mechanically without much mental effort is nothing but 'labour'.

Does your business need it?

Decision is a burden

I asked the little team out here to coordinate among themselves and arrange a meeting and find solutions to each other's problems in a group.

It was 6th of Dec when I asked them to do so. In between I was on leave. For the last 3 days again I've asked them to do the same. So far they have failed to coordinate among themselves and meet, forget about finding solutions to problems.

It tells me one thing for sure. And I can say from the way I've been in my own life as well. Somehow, taking decisions puts responsibilities on the decision-maker. And if you don't enjoy the decisions you make, then they are a burden.

This place is devoid of people who like what they are doing and the consequence is that this place is devoid of responsibility-takers. And only those who are willing to take responsibilities can become decision-makers; good ones or bad is always a matter of debate.

Little faces of change

Shave at 12:30pm!

Yes, the person who handles cash and banking related tasks was out for a shave at 12:30pm on a Monday when there is maximum rush at the hospital. No doubts on his integrity; he has been with the hospital for many many years. What blows me off is the shave at 12:30pm on a buzzy Monday noon!

What's wrong with the copy?

Wanted

Radiologist

for a multi-specialty hospital

at Bhilwara, Rajasthan

-

Compensation: Best in the industry

-

The applicant should be 

good at communication -

polite and well-spoken -

and possess a spirit to serve.

What's wrong with the copy?

I suggested this copy when we were discussing releasing an ad for a vacancy. The immediate response was doctors won't respond. What's the need to write polite and well-spoken...

It's rather strange actually. All these things are assumed to be present in a 'doctor'. The facts, as I've observed so far, do not corroborate. Doctors don't have natural ability to communicate, forget being polite and well-spoken. Doctors didn't choose the profession to serve the people. They chose to become doctors to make some money, like it happens in most popular career options.

But then in a market like this, we haven't done enough to choose. We haven't done enough to attract the ones who want to serve.

Commercialization at the hospitals

  

  

  

It's like the rivers charging for rowing.

  

  

  

  

I have become Major Saab

Coaches needed

We can do without managers in this part of the country. Only coaches needed. Men who can constantly watch, talk, utter just the right words, inspire, and reprimand and push when needed. Less on paper, more on the ground.

The truth

I am busy the whole day and the whole night.

The whole day I am shifting attention from one thing to another to yet another. When I say shifting I sound as if I make a choice. No, it's default. There's no choice. There's just no time to make a choice.

The truth is hospital has no decision-makers. Or rather the truth is that people do not seem to have the greatest judgment to inspire confidence in their decision-making and therefore they aren't allowed to be decision-makers. And therefore, it so happens that since they aren't allowed to take any decisions whatsoever, they do not become any better at decisions.

The thing is you take a decision and make them run around to follow your decision. The truth is following also involves taking some decisions. But then these guys haven't practiced any decision-making as yet. And therefore, they come running around seeking you to take more decisions.

The truth is taking decisions and sub-decisions and sub-sub-decisions keeps me busy the whole day.

The whole night I am busy sleeping and dreaming. Dreaming nightmares.

Out of the box

It's simple. I feel, it's over-rated.

We are creatures of habit. Break a habit deliberately and you are out of the box. If usually take a certain route to a certain destination, take a different one.

I just visited Ahmedabad over Diwali. Good enough to break the rut I got into staying at the hospital and trying to manage it somehow. I've come back with more thoughts, clearer thoughts and a different resolve.

Boxes are tough to see. So it's tough to be out of the box :). This awareness itself is good enough. Remind yourself time and again that boxes are tough to see. And that habits are boxes. Break those habits; you'll find yourself out of the box.

Dhanteras

Today is Dhanteras, an important day of Diwali festival here in Rajasthan.

Here's my SMS to all the members of Krishna Hospital:

--
Dhanteras par kuch aisa karein ki  log aapko dhan dene se na katrayen!

S Soni
--

The same message to you as well. :)

Doctory as career option

Observing the downright greediness of doctors out here, I asked my Doctor Mamiji if there is any specific reason why young students aspire/choose to become doctors. The answer? Nothing. Apparently it's just a good career option where 'good' means lucrative.

Doctors lack any great sense of 'service'. In all likelihood, for them patients are nothing more than just machines meant to be repaired efficiently and carefully.

During interviews, these docs talk so blatantly and unabashedly about money. Worse than even the most frugal baniya.

And physicians see themselves as nothing more than platforms which specialists can exploit and pay for use. Earning referral fee is the incentive to become a physician it seems.

It's sad.

Fired!

A few days back, I fired an old accountant who joined the hospital after retirement from government service.

Today, I fired a youngster whom I hired just a month back. Why? He was handsomely paid. He thought well, talked well but he wasn't able to conclude his tasks and depended on me to take decisions. He was a young engineering grad whom I had hired for marketing communication!

I offered him to stay but at a lesser salary. He denied.

His spirit impressed me even as he left. He was smiling. He said, "I believe in revolutions. If you think of something new (referring to a project I discussed with him just yesterday), let me know."

Intentions & Conversations

One of the things that I've shied away from on many occasions is 'conversations'.

Not any longer though! I've been talking and talking and talking with numerous people and on numerous matters - most of them petty matters.

And even when I am free, there's someone who wants to have a conversation. I suspect, people here find me good-natured. Mind you, 'good-natured' has as many negative implications as positive in this place. Couple this with the position I'm in at the hospital. And combine this couple with the earnest desire of people to fill time somehow.

These people sound the sweetest people on earth. They make spicy interesting conversations. And in each of these conversations, there's a reference to salary and money and earnings and expenses.

Tomorrow comes. I cry hoarse to make them understand how work ought to happen.

Youth of Rajasthan & 'Government' Mindset

The hospital has been facing a shortage of nursing staff. Reason? Employees, old and new, left their jobs for a couple of months to prepare for State/Central Government exams.

In fact, even some team members, who've done their 'MBAs' and are involved in the management of the hospital, try getting into government jobs.

I tried finding out what is it that makes these people consider government jobs:

• Security of job, of course
• Fixed timings. That implies not working at odd hours.
• Most of the times, no work at all and still receiving high salary
• Transferrable jobs
• Parents' pressure
• Regular salary hike irrespective of whether there's work or not

And I am talking about very young seemingly bright youngsters in their early or mid-20s. Talk about the progress of this nation. It's growing at 8-9% nonetheless!