Anything that moves

Getting Watsoned: Why robots could spell disaster for India's IT sector

Robotic process automation could drastically reduce employment in the software services sector, closing one door to prosperity for middle-class Indians.

Last week, 20 years after a computer named Deep Blue defeated the then world chess champion Garry Kasparov, a machine called AlphaGo beat Lee Sedol, the best player of Go, a game more complex than chess and popular mainly in East Asia. While that massive blow was being struck for artificial intelligence, I was attempting to get humans employed by the most respected private sector bank in India to answer a simple question about my credit card. They seemed to be trying, but were restricted either by company policy or personal limitations. I got emails from Uvaraj, Padma, Melkis, Sathish, and Gayathri, but without exception they provided cookie-cutter responses culled from some list of FAQs rather than tackling the specific issue I had raised.

If a machine could beat the best human players of Go, I thought, surely one could be designed to answer my queries better than my bank’s customer-service department. As it happens, such a machine already exists, and its name is Watson. Created by IBM as the next challenge to their artificial intelligence initiative following their world-conquering chess programme, Watson is a computer system designed to answer questions posed in colloquial language. It made a splash five years ago by beating previous winners of the popular quiz show Jeopardy, and has already found commercial application in sectors like healthcare, financial services, legal research and telecommunications. As Watson gets more powerful and less expensive, I can see it replacing the likes of Uvaraj, Padma, Melkis, Sathish and Gayathri.

Robotic process automation is already a buzzword in industries around the world. It presents a massive challenge to India’s software services sector, alongside the shift to cloud based services and away from individual data centres maintained by firms’ IT department augmented by outsourced manpower. Indian software firms understand very well a revolution is underway. Wipro has spoken of trimming its workforce by 30%. Infosys hired as its Managing Director Vishal Sikka, who has a Ph.D in artificial intelligence from Stanford. The perspective of privately owned corporations, though, is exclusively geared towards increasing profits. Shifting focus from a staff augmentation model to a less labour intensive one is a technical challenge for them, but not a moral one. That’s the way it should be, for no company can retain staff as it slides into bankruptcy.

Social disruption

Framers of public policy, however, must look at the issue from the perspective of human employment. A drop in the number of professionals working in the software services sector would be severely disruptive to the nation’s social fabric, and I don’t use the word disruptive in the positive sense it has gained in the tech world. If call centres becomes obsolete, if the BPO business is decimated, and if a range of rote jobs across the service sector fall prey to automation, as is more than likely to happen over the next decade, it will cut off what has been for the past two decades the most important pathway to affluence for educated middle-class Indians.

It was inevitable that automation would at some point push India’s software exports sector towards greater productivity. The industry has grown from its infancy exclusively by adding workers to increase earnings. The revenue firms make for each person employed has remained virtually static for years, and is abysmally low, at well below $50,000 per year per employee.

Indians were among the first people to feel the deleterious effects of technological progress, when the textile sector was mechanised two centuries ago. We were spared the disruption caused by the mechanisation of agriculture, depicted most movingly in John Steinbeck’s novel about the dust bowl, The Grapes of Wrath. We avoided the worst effects of improved efficiency in industries such as steel, efficiency which created the rust belt in the United States. We avoided it mainly because Indian companies are forced to keep on their payroll staff they no longer need. JSW Steel manufactures more or less the same amount of metal as the Steel Authority of India, but has a workforce only one-eighth the size of SAIL’s and a labour cost per tonne of steel one-sixth that of the public sector behemoth.

Blundering on

The technological revolution in telecommunications and the Web of the first decade of the twentieth century helped India even as it hurt workers in affluent nations by opening up the potential of offshoring. The current revolution is likely to be less benevolent. Many of the jobs that were Bangalored in the past decade-and-a-half will now be Watsoned. And no government regulation can prevent the haemorrhage.

Oblivious to these monumental changes, engineering schools have proliferated around the country, to the point that we now produce hundreds of thousands of mostly mediocre graduates each year. Even though the central regulator clamped down recently, we have a massive oversupply of engineers possessing only rudimentary skills. With software service providers needing to climb the value chain, there are going to be fewer opportunities for everybody but the very best grads.

India’s ITES industry employs between 3 million and 4 million people directly, which might seem like a drop in the bucket in a nation of over a billion. But consider that some 94% of India’s workforce is employed in the unorganised sector and that the government accounts for the majority of jobs in the organised sector. ITES provides one in every four jobs within the privately owned, organised sphere, which is a massive chunk, commensurate with its disproportionate contribution to the nation’s exports and GDP. Should employment in this sector fall, it will be like being shaken awake from a wonderful dream.

Recognising the danger

I’m not sure the government is adequately cognisant of the threat. Among its signature initiatives is "Skill India", which appears laudable in theory but is confused in practice. KPMG was tasked with projecting the future of employment opportunities in India. Its report on the software sector forecast an increase of 2 million jobs over the next seven years. This is an inordinately sanguine outlook, not shared by any expert I’ve read on the subject. When every major firm is speaking about cutting flab and projecting workforce reductions up to 30%, when many smaller companies seem unlikely to cope with the tremendous technical churn underway, and when corporations across the US and Europe have mandated cuts to their IT budgets, where are those two million extra jobs going to come from? It’s like somebody doing a survey of the steel industry in 1975 and predicting a 60% increase in the workforce over the coming decade.

As an aside, a second technological revolution threatens our best paid blue-collar workers. I am speaking of the six million Indians employed in countries in West Asia wounded by plummeting oil prices. So far, Gulf nations have dipped into their cash reserves to keep investment up, but austerity is around the corner, and around the next corner is recession, should crude prices stay low for years as they probably will. I believe that 30 years from now places like Abu Dhabi will be what Detroit is today, formerly glittering centres of wealth reduced to a shadow of their former selves. Migrant workers are going to get fracked in the process even as Bangalore gets Watsoned. What happens when much of the $35 billion remitted annually by Gulf workers dries up? More generally, what if the demographic dividend of which we are so happy reverts to the nightmare of overpopulation it was in the 1970s, with millions of young men and women growing frustrated and angry at the dearth of decently paid or reasonably secure employment?

I am not suggesting that doom and gloom are assured. New technologies could open up vistas nobody can see right now, creating new spaces for graduates as well as blue-collar labourers. But we should always factor in worst-case scenarios, and I don’t see anybody in the policy establishment doing that at the moment.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.