Who Cares About Care?

Corporate hospitals have become more hospitable. Hospitals too are star rated just like the hotels. There are five star hospitals that provide almost all what you can expect in a five star hotel besides oxygen from the ventilator and sundry other life-support services. Hospitals ‘treat’ patients while hotels are a place to ‘treat’ friends or family! Healthcare is what the industry is called, while most hospitals remain disease cure centres.  

In a recent blog written by Prof. Henry Mintzberg (McGill University, Montreal) he discusses the question on who should manage a hospital. In a quick analysis he says that a typical doctor is focussed on cure, the nurse is focussed on patient care and the administrator is focussed on controlling the operations. Therefore, individually none of these fit the bill to be the best CEO of a hospital, barring exceptions. However, he suggests that someone with fair knowledge and experience of the hospital operations should manage the hospital.

A large multi-speciality hospital catering to different kinds of patients is a fairly complex organization to run than a typical industrial organization focussed on one industry segment. Every moment can be critical to the life of many customers going through the hospital system. However, like other organizations, a hospital too employs a number of people of varying skill endowments performing different roles in different departments. They too deal with external vendors who provide medical, surgical and general supplies and allied services. Like other organizations a hospital tries to satisfy its customers and in the process some of them also get dissatisfied and go to other hospitals and worse, some of them are carted out as dead bodies.

In a hospital cure has limitations, care is always felt not enough and control is in many hands and at times goes out of hand! So the challenge is in maximising all the three aspects- cure, care and control. Advancement in technology and medicines tend to improve cure for increasingly large number of diseases. ERP software and management expertise tend to improve control and efficiency of hospital administration. However, care remains largely in the hands of relatively underpaid and usually less than motivated nursing staff.

While reflecting on these, I felt these three aspects in the running of a hospital probably apply equally to most other organizations. Any business has to deal with the immediate problems that need cure or corrective actions. The employees and other stake holders need care-a certain level of comfort, facilities, regular communication and recognition. A number of internal and external processes and exceptional behaviours need to be controlled.

Where does most of the management time get expended? Bulk of the management time is spent on problem solving and planning and controlling resources, processes and people. These are, no doubt, priority areas for any organization to focus. But who cares about care? Customer care has become priority for many businesses either because it is a business survival issue or it is a very profitable thing to do. In competitive industries clients can switch vendors if the service is poor. Many product businesses make most of their profits from after sale services which they control either directly or through designated channels of partners leaving very limited choice to the customers. Employee care is less so and caring for the society and environment is even far less so. Here lies the imbalance in the practice of business management. 

‘The art of medicine consists in amusing the patient while nature cures the disease.’ – Voltaire

Sparkling Joy

With Christmas and New Year around the corner most people are in a season of happiness and good cheer, like in other festive seasons. Who doesn’t need a break from the drudgery of daily life with an occasional uplifting experience or at least a perception of happiness? So I thought I will write something that will go with the positive mood in the misty air.

One of my friends recently sent me his latest article largely influenced by the Buddhist philosophy, his experience and wisdom. The underlying thought is that for lasting peace one needs to get into a state of still mind. This can be achieved by the practice of meditation and purposeful or passionate involvement in any activity that takes you into a ‘flow state’. This thought is very appealing, logical and probably experiential for many. In fact, most religions teach this principle in some way or other. The ultimate attainment of ‘salvation’ or ‘moksha’ is the absence of friction, conflict, duality etc., Such a blissful state of mind is like the quiet flow of a river or the still waters of a lotus pond.

We find fine and glittering sand particles on the sea shore and smooth and shiny pebbles on the riverside. Both are serene sights. The flows and ebbs of sea waves break rocks into fine sand and the continuous flow of river water makes rough stones into smooth pebbles. Possibly water is the smoothing agent. We also know that water doesn’t do this architect’s job intentionally, nor does the rock purposefully go for a swim in the river or the ocean. They happen to be there and the motion is influenced by other factors such as wind, gravity and air pressure etc.,

A recent video shared on Facebook showed a swift and amazing flow of broken stones and pebbles in a desert of the Middle East without a drop of water seen anywhere. So, to be in the flow, it is not necessary to be in the form of a liquid. A billion galaxies are moving in a near perfect flow state with occasional mis-alignments creating major and minor cosmic tremors.

Some years back during my first visit to the USA I had a small experience with ‘still water’ in a Dallas restaurant. While having dinner the waiter asked me if I would prefer ‘still water’ or ‘sparkling water’ to drink. That was the first time I was hearing the term ‘sparkling water’. I was more used to soda water, club soda, carbonated drinks etc., in India. So it did not instantly ring a bell in my mind that it is just another term for the humble soda water. Yet, the word sparkling ignited a spark and therefore, I opted for sparkling water without knowing what it was. Possibly my sub conscious mind would have processed the decision thinking that anything sparkling must be better than something still and dull. No doubt the dinner was a sparkling experience with lots of youngsters cheering their favorite players while watching an interesting baseball match on the large screens.

Fresh lime added with sparkling water and a few mint leaves provides a refreshing experience, just as the sparkling water when added to certain other liquids uplifts the spirits. Where does the water gain the sparkling quality from? Interestingly it is the air that is making the sparks. It is common belief that life forms evolved from water. Yet, we also know that life is just a matter of a breath (of fresh or polluted air). So we have breath taking ecstasies in life when we experience wonderful surprises and heart-stopping near death or real death when the wind refuses to travel back and forth the pipe!  

What is your preference? A still mind of ‘nothingness’ or a sparkling mind of ‘something-ness’? Either way you are blessed. Let life be a journey of alternating experiences between still joy and sparkling joy. Enjoy the season!

‘Most folks are about as happy as they make up their minds to be.’ – Abraham Lincoln 

‘Like’-Minded People

We all have many likes in life and many things and people we do not like. The way we express our likes and dislikes (or should I say ‘unlikes’?) vary from person to person and situation to situation.

Before the advent of social media people expressed their likes and dislikes with fairly the same mental ease though the proportion of likes and dislikes expressed in public varied from person to person. Broadly we can place people into three categories on the like-dislike scale. There are some people who are miserly in expressing what they like but too eager to express what they don’t like forcefully. On the other side of the scale is the kind of people who are expressive about their likes and possibly hide what they don’t like. And there is the third type of people who are on balance expressing their likes and dislikes in more or less equal measure.

However, in recent times I see a broad change in the pattern of expressing ‘likes’ and ‘dislikes’ on the social media. People who post anything or share somebody else’s post want other people to like their post. That’s natural. Everyone wants positive affirmation, if not appreciation. The general trend on social media is that people who like a particular post, an opinion, a picture or a video clip quickly click the ‘like’ button. However, a vast majority of those who do not like a post do not click the ‘unlike’ button. People seriously hesitate to express their dislike for a view on social network. Not that all such people are incapable of disagreement with a view posted by a friend or colleague.

Do you experience this in your social media behaviour or at least noticed others behaving this way? I do experience this in my own social media behaviour and I notice several others doing the same way.

Why do people behave this way? There could be many reasons. Here is a sample few.

1. Most people do not want to disagree in public, that too on an indelible medium. There is a record of who liked what and who ‘unliked’ what and you have no chance of editing or correcting.  Unlike a personal conversation the social media is overly public for a meaningful conversation.
2. The fleeting nature of the social media message doesn’t often allow people to think through an issue and express a considered opinion. Everyone is expressing the top of mind views rather than what is deep in the mind. Liking someone’s view is much less risky than ‘unliking’ someone’s view. You don’t need to explain why you like something; but often you need to explain why you don’t like something or someone. That is the unfair and unwritten expectation on the social media. So, if you don’t like or agree on something the safest thing is to keep quiet and stay away from trouble.
3. Most people place harmony above truth. If by saying the truth you are likely to alienate your friend you are likely to choose to be nice and agreeable rather than truthful. Most people seem to be always on a congeniality contest! Friendship is valued higher than honesty on the social media. Maybe because most of those who you have ‘friended’ on Facebook are in fact ‘friended’ friends than real friends. The friendship band here is tied on very fragile threads. With real friends you have the freedom to disagree and dislike.

Are you a ‘like’-minded person?  

‘There are two freedoms- the false, where a man is free to do what he likes; the true, where he is free to do what he ought.’- Charles Kingsley  

Toilets and Training

A recent news item in the Economic Times reveal that of the 10 Million new toilets built under the Swachh Bharat Abhiyan in the last one year since the program was launched only less than 50% is used for the purpose for which these were built. Not that this is happening only in the rural areas, even in the urban areas the trend is no better.

We know that in India government spending on social welfare often misses the target. However, unlike the Public Distribution System for food grains, sugar or kerosene, toilets cannot be sold in black market. So why is it that even in such a non-tradable product only half the users benefit from the initiative? It is not that the other half families are not using these toilets. Many of them use these new structures for storing food grains and other agricultural items. They think a nicely built enclosure is not to be desecrated by the daily dose of excreta when there are enough greener, bushy and airy open spaces available for the job. Sound logic it may sound!

Probably there was some defect in the problem definition. The problem got stuck with the toilet. The problem was seen as a large number of Indian families not having ‘pucca’ toilets. Therefore, the solution was straight forward. Set a target to build a certain number of toilets within a specified time. Budgets allocated, contractors identified and the job done! This is not to show the initiative in poor light. The initiative is very laudable and the 50% success made a big difference to five million families. The initiative involved acknowledging an acute basic need, financial planning and physical implementation.

When we broaden the problem to define the need as health, hygiene and safety of the citizens the solution will not stop at the toilet door. The solution should result in using toilets for the intended purpose. That would need a change in the behaviour and eventually developing new habits in life. Behaviour modification often needs much more than physical infrastructure and budgets.  

Psychologists and training managers know this. Behaviour modification is no easy task for any one, leave alone the government agencies. Corporate companies with defined KRA’s (key result areas) and incentives find it difficult to change the behaviour of people. Everyone is comfortable the way one has always been.  

Over two millennia ago Plato found that ‘human behaviour flows from three main sources: desire, emotion and knowledge.’ Notice that even the great philosopher places knowledge at third place when it comes to human behaviour. Repeated communication and demonstration of benefits, along with adequate incentives would be required to break the gravitational orbit of entrenched habits. That would probably kindle the desire for a new behaviour and eventually lock in the new habit with some emotional glue.

Let’s come back to the toilet revolution. Changing a daily habit is surely not a day’s task. It needs many attempts and continuous motivation. Trained and motivated village level officials or volunteers working with the beneficiaries could have achieved higher usage of the newly built toilets. Motivating the motivators is the bigger challenge in the government bureaucracy as well as in the corporate hierarchy. Training without motivation results in wasted resources.

Exit Polls and Exit Interviews

For the two days preceding the Bihar election results on 8^th November 2015, most TV channels indulged in serious as well as trivial debates based on exit polls sponsored or partnered by the respective broadcast companies. If we take the average of nine different exit polls that got published NDA was to win 119 seats and the Grand Alliance to win 117 seats. In other words, all the pollsters predicted a narrow victory to one of the two formations. Obviously, the real outcome on the 8^th of November was miles away from the predictions by the exit pollsters.

It was intriguing to most rational Indians as to why is it that a country that launched an unmanned spacecraft to the Mars can’t do an approximately accurate post poll survey.

Well, not completely true. There was one exit poll agency (Axis) which predicted between 169 and 183 seats for the Grand Alliance and 58 to 70 seats to the NDA. They were the most accurate going by the final outcomes. But unfortunately the channel that sponsored this agency refused to air their findings for some unknown reasons.

We knew that millions of citizens cast their votes in Bihar. We also knew that within 48 hours of closing of the last phase of voting the actual votes will be counted and results published by reliable government machinery. Then, what value is added by two days of discussions around highly unreliable and speculative predictions of those exit polls?

The answer probably is: pure entertainment. The dance of democracy is the new Bharatanatyam! The voter fooled the pollster, the pollster fooled the media company and the media company fooled the public! These exit polls didn’t serve any other useful purpose.

You would tend to think that such purposeless things happen in media and politics, but not in private companies. Wait a minute.  Corporate companies conduct exit interviews when employees quit, just as the exit pollsters conduct interview with the voters after they have voted. Fortunately they don’t figure as much in the TV debates and media and hence the public is spared. Exit interview results are meant for private circulation. Many companies do this as a mandatory agenda of the employee separation process. The hope is that employees give honest feedback when they are leaving the company and the objective is to use the feedback for improving the way employees’ careers are shaped or facilities provided to potentially reduce the rate of employee attrition.

Very noble intention, indeed! But does it happen? No is the frequent answer. Why?

In many large organizations, often an HR representative or a third person conducts the exit interview. When the employee is loosely engaged with the organization she does not have much motivation to give an ‘honest’ feedback. Even if she wants to give an honest feedback she will think it unwise to make any sharp (read truthful) comments. Instead she will make some generally accepted positives and a few improvement areas to get out of this one item from a long exit checklist. She knows that there may be some reference check in future or for a safe return to the same company it is better to play safe now.

The person administering the exit interview too is doing this last ritual with a sense of detachment and a sense of duty rather with a sense of purpose. Someone with a sense of purpose will probably go beyond the format and seek genuine feedback. This too is an ideal situation rarely happening in most organizations.

Now, assuming there is indeed some genuine and useful input coming from the exit interview reports, few in the management hierarchy has time and mind share to delve into the underlying messages of the exit interview feedback. In best organizations this can be the last agenda in an otherwise packed business review. In other organizations, the exit interviews are done, circulated among some managers, quarterly summary made, quickly glanced and forgotten.

      So what needs to be done with exit interviews? Here are some suggestions.      

1. Make the exit interview voluntary. Let the employee decide if she wants to share any feedback at the time of leaving. Probably a few voluntary responses are better than a lot of mandatory interrogations. 
2. Provide multiple ways for an employee to provide exit feedback. (a) employee post on a specified site either under signature or anonymously; (b) send feedback in mail to the manager, manager’s manager or to HR representative; (c) talk to a company person in confidence, without any recording.
3. Pick one important or recurring feedback every quarter, act on it and broadcast to employees about what is done.
4. Complement the exit interview feedback with regular stay interviews (check what makes the employee stay with the company, and what will make the stay more meaningful and enjoyable) with random employees or on the basis of some stratified sample.
5.  Enhance engagement with employees- by managers, leadership and HR on a planned manner to make the exit interview eventually redundant.

Why do companies conduct interviews at the time of recruitment? Because, they are strangers and there is a need to know them before taking a hiring decision. Why do companies conduct exit interviews? May be because employees are still strangers in some way!