note demonetisation

For India's middle classes, demonetisation has become a moral project

The Great Event has little to do with economic logic.

It is November 8, the night of the Great Event and I am watching NDTV. The clean-shaven presenter can barely contain his excitement. He prances around like a peacock. His pastel post-Nehru jacket is like an emblem of a new era of which he is the heart and soul.

He is catatonic with delight, the microphone jutting from his fingers like a symbol of self-righteousness. Tonight, he has nothing to fear, he exclaims into the mike, for he has no black money. Those with mountains of Rs 500 and Rs 1,000 notes will now get no rest as the government has declared that starting midnight on November 9, these will no longer be legal tender. His moral apoplexy has reached a crescendo. He seems to be laughing on the inside as well. His being is equal parts pleasure and condemnation.


Delhi’s Valmiki Colony is tucked into a tiny corner behind the upscale Malviya Nagar in the city’s southern part. I am here to do some field work on a topic that has nothing to do with money, except that everyone here is poor and so, money-talk is a constant. It is the night after the Great Event and we are crammed into a tiny room where a family of five lives. The father is a vegetable vendor and the mother is part of a neighbourhood self-help initiative started by the Delhi government.

The lanes of Valmiki Colony are so narrow that if you stretch out your arms, you could nearly touch the walls on either side. Almost everyone in the room had Rs 500 and Rs 1,000 notes on the night of the Great Event. The room-owner tells me that he uses the proceeds from the day’s sales to buy vegetables to sell the next day. Like many street vendors in India, he too does not have a bank account.

According to a recent media release by the National Hawker Federation, around 50 % of such workers do not have a bank account. The number of workers in the wider informal sector of the economy who do not have any relationship with the financial sector is higher. Cash flows in to his one-room house every evening and then out the next morning. And, the others in the room? Would they go to the bank the next day to exchange their cash into legal tender? A woman who sells peanuts says that she fears entering one as banks “treat us like dogs”.

Higher moral ground

On Day three after the Great Event, I am at work and saunter across to the local branch of the bank where my salary is deposited. The clerk and I exchange pleasantries. He tells me that “new cash” should arrive sometime late afternoon and I would be able to withdraw my Rs 4,000 then.

I go my back to my office. There are emails to be attended to, work to be done, visitors to be greeted. And, of course, WhatsApp messages to be viewed. There’s been an unending flow of messages about the Great Event. The one I read over and over again says that all discussions regarding demonetisation should include representatives from the armed forces. “When these guys are struggling on the border, the aam junta can’t even face hardship for a few days,” the sender says. He concludes that all politicians who question the Great Event should be sent to spend time with soldiers at the border. This is met with a flurry of thumbs up responses from those within the border.

The Great Event is not just financial in nature. It gives vent to a new project within which the middle-classes seek to define their morality as a class. Accusations of obsessive consumerism, lack of interest in public and collective life and abandonment of even the pretense of the idea of distributive justice can now be countered through economic jingoism.

Economic logic suggests that since a significant majority of the Indian population is not part of the formal financial system, cash accounts for just about 6% of undisclosed income recovered in income tax raids, and the processes for generating black money remain in place, the Great Event might not be all that it seems. But, the moral project that surrounds the Great Event has little to do with economic logic.

War on finances  

Being middle-class in India has always been about moral claims to being certain kinds of people. In the current period, this has taken on new dimensions.

First, there is remarkable resurgence of anti-poor sentiment. As the idea of citizenship transforms from a political ideal to one defined by the market – the consumer-citizen, as some call it – there is great antipathy for the poor and their everyday lives. They are seen to be bad consumers: stealing electricity, encroaching upon valuable urban spaces with their slums and not allowing corporate conglomerates a free run over their lands for mining and industrial activity. The moral middle class, on the other hand, has achieved its success through sheer hard work and intrinsic merit.

Second, claims to morality are built around the idea that answers to complex social and economic problems lie in technology. The moral middle class defines itself through a deep attachment to the idea that we do not need to disturb the existing structures that make for social malfunction. All that is required is an overlay of technology. So, urban problems can be solved through Smart City programmes, better governance equals more computer kiosks, mobile apps can address the problem of women’s safety in public spaces and e-wallets (such as Paytm) will lead to a better financial infrastructure. Technology is clean. Morality is about adherence to cleanliness. Addressing social messiness is, frankly, far too threatening.

And finally, there is the new morality of violence that is seen as a purifying agent. The language of finance now builds upon that of war and matters of money are now part of the militarisation of the national sentiment. Casting nationalism in the language of violence is a moral enterprise as it rids us of the apparent cowardice of earlier eras. We are a new people and in this normalisation of violence, those who suffer are collateral damage.

Just as black money is only the symptom of a deeper process, the Great Event is an outward sign of a deeper, inner, malaise: the acts of defining the moral high ground through ever-narrowing ideas of the public good. So, the Great Event is not really all about money. The residents of Valmiki Colony and national spaces beyond them are now the contexts of a morality play that is the sign of a social neurosis. Individual neurosis can be identified by others in the community, but what happens when we are all afflicted?

Sanjay Srivastava is a sociologist and author of Slum, Gated Community and Shopping Mall in Delhi and Gurgaon.

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

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.