BOOK EXCERPT

How protectors of shaky corporate and political reputations try to silence journalists

In ‘A Feast of Vultures’, the writer recounts murky deals and attempts to buy his discretion.

When you attempt to unmask the appalling double games of the people that run India and drive its economy, and put together evidence of their duplicity, they will deploy ingenious methods to silence you. It is not always crude intimidation.

I was meeting a former journalist in a coffee shop on the first floor of Delhi’s Khan Market, one of the most expensive retail markets in the world. The winter sun poured in through the tall glass window, making it a very pleasant afternoon. That didn’t help put my companion at his ease, though. Until recently an employee of a Hindi news channel, he had just taken up a well-paying new assignment as the spokesperson of a controversial Mumbai-based billionaire.

The mild February weather had no tempering influence on national politics, where things were boiling over. Yet another scandal had erupted, and the United Progressive Alliance (UPA) government led by Dr Manmohan Singh was lurching from controversy to controversy. It was 2011, and the government still had three years to go, but there was a heavy sense of hopelessness in the air. In a few months, the country would witness a huge eruption of anger against corruption through protests in various cities.

The billionaire’s spokesperson had taken a two-hour flight from Mumbai, India’s commercial capital, that morning to meet me.

Only days earlier, his boss’s lawyers had served me and my newspaper a criminal defamation notice after I reported that he was directly in contact with the criminal underworld. We responded to the legal notice, saying we were in possession of official documents to prove our claims, and would produce them in the appropriate legal forum.

Our calm reply appeared to have prompted the business magnate to change strategy. The PR manager started with a profuse apology on behalf of his boss. “It was a mistake. The boss had in fact told his legal team not to send you the notice,” the young man said.

Both of us knew it wasn’t a mistake but the standard operating procedure of India’s rich and famous when an article critical of them appears. Over the years, I have received dozens of notices from some of India’s biggest corporates and most powerful people. For publishing a secret audit report that accused Delhi’s electricity distribution companies of massive financial irregularities, one of them served a notice demanding compensation worth almost a billion dollars. A former army chief would shoot off defamation notices every time I wrote something critical of him.

Mumbai Congress leader Kripashankar Singh, whose astonishing metamorphosis from vegetable vendor to multimillionaire was part of an official probe, was equally trigger-happy when it came to defamation notices. When I reported on a Member of Parliament (MP) who abruptly left a parliamentary committee meeting on serious security matters, which he was chairing, he sent across a notice accusing me of breaching his parliamentary privilege.

The protection of shaky reputations is a flourishing industry.

There are PR consultants whose brief is to alert the rich and famous about any possible adverse reports brewing against them in newsrooms. There are lawyers drafting defamation notices and then there are those who manage the situation if nothing else works. All of them make a killing out of the potential embarrassment of a famous client.

As we settled down after the apology, the spokesperson said, “He wanted me to request you not to write anything more about his links because our efforts to raise FDI (foreign direct investment) have suffered a huge setback due to your article.” Their company – which had manipulated its way to procuring the licence and radio spectrum to operate second-generation mobile networks, and was facing a criminal investigation – was in the market to raise about Rs 3,000 crore from an investor in the Arab world.

The spokesperson then scanned the surrounding tables and, with sweat trickling down his forehead, whispered: “The boss wanted me to tell you that he can take care of whatever your needs are – car, house, whatever.”

I let the silence build, then pointed to a sprawling colonial bungalow across the road. “Do you mean one of those houses?”

Back on familiar ground, he responded: “Don’t underestimate my boss. He can take care of anything.”

I don’t remember who paid for the coffee, but I called off the meeting soon enough.

Not everyone in New Delhi is uncomfortable about making such offers.

On another occasion, a famous lawyer met me at Hotel Ashoka, the gym members of which include, among other notables, the Gandhi family. The lawyer had been spending a pretty penny to exercise next to New Delhi’s influential lot. He was meeting me on behalf of one of his clients, a company I was investigating for allegedly misusing the police to harass its rivals.

The company was backed by a political family that ruled one of the northern states, and had been accused of money laundering and other criminal activities. “If you write the article, they will be ruined. If you drop it, only you and I will know,” he said, adding that there was a budget of Rs 3 crore available for me to drop the story. When I said I should be leaving, his parting shot was that he routinely managed the high priests of India’s judiciary and politics. Why, he wondered, would I let such an opportunity pass? This time I know I didn’t wait for the bill.

My mainstream media job did not always allow me the latitude to report on this aspect of the real India I met behind closed doors and in fancy hotels, and that is finally what set me off on an inquiry into the modern nation state of India. How robust is its democracy? How fair? Have its institutions been maturing over the years? Are the waves of transparency and well-fought elections improving the lot of its poor? Are the cleavages between its institutions deepening, or disappearing? Why do other institutions not challenge the duplicity of the political classes often enough? Is everyone tangled up in a grand conspiracy to subvert the republic? Is there a way to assess and report on this modern India, without self-censorship and varnishing, without betraying my childhood village by the backwaters, without omitting friends, without being seduced by the intimate glamour of the imposing capital city?

The narratives of urban India that truly decide the fate of this sovereign, socialist, secular, democratic republic remain unwritten, unreported. Constitutional lawyers manage and manipulate media coverage and public perception of almost every issue; bribes and intimidation are what you need to get your way; billion-dollar deals go through only if the right people are paid; political parties collect black money to fund their operations; coverage in the media is available for a fee and paid news is officially a business; civil servants assist the political class to subvert the system; “facilitation” is the most successful business in its booming economy. Everything and everyone (with a few honourable exceptions) is on sale. You only need to find the right intermediary and pay the right bribe. The creaky government machinery moves only when the lubricant bribe is applied.

Excerpted with permission from A Feast of Vultures: The Hidden Business of Democracy in India, Josy Joseph, HarperCollins India.

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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.