Charge of the Light Brigade

They have weathered the storm, marched towards battlefields, endured testing times and now they are here in healthcare to make a difference. Nayantara Som makes you meet the men in uniform

They came, they saw, they conquered. They have been put through a field that puts before them the most challenging tasks and through testing times. They are the 'officers in uniform', the officers from the defence now in healthcare.

Today, they have become the backbone of their respective institutions, respected for their commitment and integrity and revered for innovative concepts that they have introduced in healthcare.

Why the Shift to Healthcare?

The reasons are diverse but the common underlying factor for the shift, as claimed by the men in uniform, was the window of opportunities that opened up when healthcare came knocking at their doors. Claims Dr (Major) GVJ Prabhakar, General Manager, Operations, Global Hospital, Hyderabad, who was in the Indian Army for five years followed by a 13-year-stint in the Royal Army of Oman, "There is so much to do here. Moreover, in a corporate set-up, the work pattern of employees is flexible and you are allowed to give in your independent ideas. This is not possible in the rigid framework in which the army operates," says he.

Unlike stereotype opinions, there were no hitches or second thoughts while joining the field because the two fields are almost same as far as their managerial techniques are concerned. Claims Brig Joe Curian, CEO, SL Raheja Hospital, Mumbai, "Defence is about gathering together your artillery, air-power for a point of application that is the battlefield to achieve your target. Healthcare, too, follows this concept." The only difference being that the risk factor in the defence is enormous because it involves human life.

MARCHING AHEAD
Then	Now
Brigadier Joe Curian was only 19 years when he was commissioned for the Indo-Pakistan war in 1965	Today, as the CEO of SL Raheja Hospital, he has brought hospital from a loss of Rs 2 lakh to a profit of Rs 2 lakh
Colonel RL Sharma fought the Indo-Bangladesh war in 1971	As the Hospital Administrator, Ruby Hall Clinic, he is a stickler for discipline and takes strong action against people breaking rules
Dr (Major) GVJ Prabhakar was in the Indian Army army till 1991 and subsequently joined the Royal Army of Oman for 13 years	As the General Manager, Operations, Global Hospitals he introduced concepts like Sliding Scale to keep a count of patients and streamlined man management

The Strategies

Logic Works: These men lay emphasis on transparency, accountability, logical and rational approach and methodical working. When Brig Curian joined Raheja Hospital, he faced the challenges of dealing with the demands of a powerful union which called the shots in prime decisions like promotion, recruitment and demotion. Dharnas were a common feature of the day. "I believe in logical discussions. I sat down with them and threw open the accounts books before them rather than concealing account facts. They then realised that they were making demands which could not be met," says he.

At Chennai’s Frontier Lifeline, the recruitment process became streamlined when Colonel DK Sabapathy, Manager, HR and Hospital Administration, introduced the system of establishing committees at various levels, doing follow-ups with people who were joining or not joining and also introducing the element of accountability. "The system of committees was there before, but when I came in, I made the process more streamlined," he says.

Strict Discipline: These men in uniform have been appreciated for ushering strict discipline, be it punctuality or following the code of conduct. Even if the other senior people come much later, the army people are there early in the morning. Asserts Colonel M Masand, CEO, Jaslok Hospital, Mumbai, "When I came to Jaslok, there was absolutely no discipline. Now 12 o'clock means sharp 12'o'clock. Latecomers cannot be forgiven." Colonel Masand is such a stickler for discipline, that every morning he ensures that the security staff does a drill. “This will keep them healthy and fit throughout the day," he says.

Says Frontier Lifeline's Manager-Maintenance, Colonel Samuel Raj, who fought the 1971 war, "Earlier, there was no system of employees reporting to the concerned heads when they had to take a day off or two. Now that system has been introduced here." In the same hospital, his counterpart, Colonel Sabapathy introduced the system of Access Control System where employees were given swipe cards and their entry and exit timings were recorded. "Employees who were irregular were immediately tracked down, and at the end of the month, their salaries would be cut accordingly," recalls Colonel Sabapathy.

When Colonel RL Sharma, Hospital Administrator, Ruby Hall Clinic, Pune joined the hospital way back in 1996, it was in a deplorable condition. He recalls, "Indiscipline was the practice. People at the admission desk were drunk, ward boys would abuse the nurses and some would sleep on their job. It was then that I took charge and fired people." Same with Col Masand when he joined Jaslok Hospital in 1993 as the Director General. When he realised people were siphoning off money and working inefficiently, he sacked them and got a new workforce. He claims, "I then brought in men from the defence and set up a team. This made administration easier for me."

"The defence is all about team work and leadership. That is our strength and that is what makes us emerge as winners in the end" - Colonel M Masand, CEO Jaslok Hopital, Mumbai Secunderabad

"The army definitely teaches you to handle man power in an effective manner. At the same time, it teaches you to tackle them" - Dr Padmini Valluri Gynaecologist Yashoda Hospitals

Planning & Resource Allocation: It is a fact that management principles and mantras taught and practised today by B-schools have their origins in the defence. Principles like cost-effective measures, task management, technology, utilisation of resources and manpower have their roots in the defence. Major Prabhakar, for instance, introduced the concept of 'Sliding Scale' at Global Hospital, Hyderabad. "We had used it in the army. In the Hospital, I introduced it to calculate the number of casualties coming in to the hospital, the number of patients coming in to the hospital, whether there has been an increase of patients or technicians." This is in keeping with the trend of the defence forces where each and every minute detail is laid down and documented.

Brig Curian, who believed that healthcare was on the disorganised side when he joined Apollo Hospital, Chennai in 1998, introduced the concept of the 'Selection and Maintenance of Aim', also known as the principle of war. This mantra aims to help an organisation focus on its goals and mission before embarking on a task. "First and foremost, an organisation must have a vision and mission. In the army, this helped us to be focused in our tasks. In healthcare too, the principle helps us to decide and focus on our targets," says Brig Curian.

It stresses on the principle that the vision should permeate from the apex of the pyramid down to the bottom. "A sweeper should tell me that ‘my job is not just to clean the hospital, but to contribute to the welfare of the hospital’," adds Brig Curian, who fought the Indo-Pakistan 1965 war when he was only 19-year-old.

On the same lines, at Sankara Nethralaya, Chennai, Lt Colonel N Raghavan, Advisor, Projects, who was in the core engineering sector in the army for 24 years, joined the institution to convert it from a multi-speciality hospital to an institute for ophthalmology. He introduced the concept of Project Evaluation and Review Technique (PERT), whereby a project after being conceptualised in the mind is planned in a meticulous and a step-by-step manner. Drawings of specifics are put up. It is deliberated and planned out, activities are divided so that execution takes place in a smooth manner. It also contributes in the process of evaluation and deciding whether a plan is going on in the right course.

On the same lines, Lt Colonel Raghavan then introduced the concept of 'Course Correction' as it used to be implemented in the army. 'Here, if a plan was not executed in the right manner, we plan again and take a course correction method," adds Lt Colonel Raghavan. For this, blackboard diagrams, chart planning, which is a usual feature in the defence forces, was introduced at Sankara Nethralaya.

Another feature is the introduction of the Standard Operating Procedures (SOP), set of procedures to perform a given operation or evolution or in reaction to a given event.

At Frontier Lifeline, Colonel Sabapathy introduced this concept in the administration. "I saw to it that SOPs were introduced so that every event and function in the hospital is documented for further reference," says Colonel Sabapathy, who injured his left leg during the 1971 Indo-Pak war.

Jaslok Hospital also introduced the concept of SOPs. Says Colonel Bhim S Khemani, who was in the army for 27 years and now the Executive Director, Jaslok Hospital, "Documenting everything in a hospital helps you to improve upon procedures, technology and norms which are patient friendly." Again Colonel Masand, who fought the 1971 Indo-Pak war, sees to it that regular meetings are held with all the departmental heads to keep a count on the number of patients coming in the last 24 hours and other important issues of the hospital.

Man and Equipment Management: The defence force also teaches one the art of handling manpower. A common feature for most of these experts is the emphasis on human management. "It is not just management, it is the amount of motivation a leader gives a soldier. Soldiers are trained and motivated to such an extent that they are ready to march to the battlefield and sacrifice their lives. After a stint in the army, handling men in any sector is a cakewalk," says Colonel Sharma. However, Dr Padmini Valluri who was the Lieutenant Colonel in the army and now a Consultant Gynaecologist at Yashoda Hospitals, Hyderabad gives another perspective, "The army definitely teaches you to handle man power in an effective manner, but at the same time it teaches you to tackle them. Unlike the army where people are punished for disobeying orders, here it is different where norms are a little flexible." For these experts, working in healthcare becomes easier because both the defence forces and the healthcare industry are man-power intensive industries. "Management is in the blood of every army man. He goes through that process for 20 years and hence good administration is ingrained in him," says Colonel Masand.

Ruby Hall Clinic under Colonel Sharma constantly checks its equipment and tests it to keep it functional. "We have the annual maintenance contracts in which we outsource this responsibility and then we also have an in-house department handling this responsibility." Lt Colonel Raghavan introduced an innovative concept. Sankara Nethralaya had generators which were the cause of fluctuations and disturbance. "I had constructed a cinema hall at Leh using local materials which made it sound proof. I used the same concept of designing generators which were sound proof and did not cause any disturbance." Adds Brig Curian, "When you are in the army, you have to be a well-informed person and it is here that the equipment and intelligence play important roles. It is same in healthcare." Same was the obsession with the tech-savvy Colonel Masand. Today at Jaslok Hospitals, he is attributed for bringing in the latest technologies like the PET and the SPECT scan, the latest version MRI and believes in continuously upgrading the machines.

When the Going Gets Tough

There had been some stumbling blocks for these experts on immediately joining healthcare. For a person who was moulded into a routine of discipline, commanding and obeying orders without batting an eyelid and then subsequently adjusting to an environment which is comparatively informal and flexible is indeed a daunting task. To top it all, there have been instances where experts had to face resistance from other employees because of the rigid orders and rules enforced by the men in uniform.

At Ruby Hall Clinic, due to the critical condition of the Hospital, Colonel Sharma had taken tough actions which included not just suspension but even firing employees for breaking orders. "People went against me because of the strong action I took—to see that everybody was doing his job without any ifs and buts." Colonel Sharma had a tough time initially when he had to battle out both the employees resistance and also the strong union that existed in the hospital. People could not adjust themselves with the trend of 'obeying orders' without any further questions. Recalls Colonel Masand, "Any order that I would pass would generate discussion rather than obeyed to. In fact, when I came here, everybody had their hands on other people's necks." He further claims that he stuck to his guns. Dishonesty had no place in his lexicon and he did not hesitate to show the exit door to those who refused to adhere to his orders.

The Fruits

However, when the going gets tough, the tough gets going. Rules, orders and strict discipline have their long-term benefits. Employees in most of these organisations realised that these were done for the profit of their hospital. Automatically, the resistance and repulsive attitude stopped. This is reflected in the turn around stories of hospitals under these men. Prior to 1993, Jaslok Hospital was a sick hospital. Colonel Masand changed all that. With the introduction of the element of transparency, discipline and SOPs, the Hospital is now riding on an all-time high and is all set to go in for a NABH accreditation. Again take the instance of Brig Curian. After a stint as the CEO at Apollo Hospitals, Chennai, he joined Indraprastha Apollo, New Delhi as the CEO. "Within a period of two years, I made the hospital cash neutral," he recalls. This is not all. Prior to 2003, PD Hinduja Hospital, Mumbai, was a sick hospital facing a loss of a whooping Rs 6 crore every year. Life took a sharp U turn once Brig Curian joined as the CEO. Nightmares for the Hospital were over as it now enjoyed a profit of Rs 52 crore! The case of SL Raheja was even worse, as it faced a loss of Rs 2 lakh every day and now it is riding on a profit of Rs 2 lakh everyday! "The defence is all about team work and leadership. That is our strength and that is what makes us emerge as winners in the end," gleams Colonel Masand. With the storms over and the battles won, the brigade is all set to take healthcare to new heights.

nayantara.som@expressindia.com