Literature and history

Why ‘Ghachar Ghochar’ is the one novel that (presciently) sums up the state of the world today

Think of the liberal elite getting snarled while events take their own course.

At the risk of being lynched by the hordes who are terminally Angry Online, I would say that 2016 was something of a logical conclusion to an extended period of a certain luxuriant passivity. We saw Britain returning to an unsophisticated nativism, America electing a prolific sex offender, a host of micro-aggressions against various minorities making the news every month, and now France looks like it’s going to elect a prime minister who seems more appropriate as the admin of a Facebook page for Race Science enthusiasts.

During this time, the pundit class, the commentariat and pollsters finally unravelled themselves as a class of society whose conception of the world and their surroundings could be compared to that of an entitled housecat.

How we’re adjusting

All of these incidents had stern precedents in the past, both near and distant, Turkey, India and the Philippines moving to elect belligerently insane strongmen, and factors like neoliberal economic values, the spread of global capitalism promising us all the world, eventually offering an Uber ride from the airport for a select few. Indeed, all the journalistic buzzwords of “fake news” and “post-truth” have been around for ages (think “Weapons of Mass Destruction” and all the just, noble wars that the past few decades has seen and condoned), while journalists desperately bandy them about in a feeble attempt to grapple with the ground giving way beneath their feet.

Politicians lie to us compulsively, never offering a vision for the future but peddling a paranoid idea of the present. Financial institutions have only become far more emboldened in carrying on their merry business of making this world a cut-throat, individualistic, living hell. The really terrible part is that most of us are extremely aware of all this, and the previous staid, clichéd passages have merely been an exercise in summarising and organising concerns that we’ve all had, some of which transcend traditional Left- Right binaries of discourse.

This is because we’re a “hypernormalised” bunch, as the BBC documentarian Adam Curtis points out, borrowing the term from a Russian writer writing around the time of the collapse of the Soviet Union to describe a society that is fully aware that things are not normal, but has acclimatised to the ethical absurdity of their situation. Along with the hypernormalised, there are those who feel they’ve been slighted, humiliated and left out of the grand narrative, leading to what Pankaj Mishra astutely diagnoses as a sense of ressentiment, or “a whole tremulous realm of subterranean revenge, inexhaustible and insatiable in outbursts”, as Nietzche defined it.

The novel gets it

Both hypernormalisation and ressentiment constitute some of the larger themes of Ghachar Ghochar written by Vivek Shanbhag in Kannada and translated into English by the writer Srinath Perur, which is easily one of the finest novels to come out this year. At 115 pages, its slightness belies its depth as it traces the trajectory of a lower middle-class Bangalore family climbing though echelons of society after starting an enterprise that packages and distributes wholesale spices. This is done through the lens of an introspective, perceptive narrator who suggests “It’s true what they say – it’s not we who control money, it’s the money that controls us. When there’s only a little, it behaves meekly: when it grows it becomes brash and has its way with us.”

The Bangalore setting is important. Over the past few years, the city has seen primeval bouts of rage directed towards the North-Eastern community, African students and a host of inanimate objects of Tamil provenance. However, Ghachar Gochar is interesting in that it offers us the story of a native Kannadiga family which gained social and financial mobility as the city prospered, as opposed to the common narrative of techie outsiders swooping in, making great fortunes and perpetuating a grotesque inequality.

Shanbhag doesn’t go for the money shot – he evokes Bangalore rather subtly through the city’s unique rhythms, the talk of rusk from a particular bakery, the maladroit architecture of its lower income housing and most astonishingly, he portrays Koshy’s as the narrator’s primary adda without slipping into priapisms of cheap romanticism that every Bangalore writer is liable to.

No agency

The title, Ghachar Ghochar, which is a nonsense phrase translating into a situation that is irreparably tangled, betrays the narrator’s fatalism, helplessness and passivity. Through the course of the novel, we see that the bonds he shares with his family go from the familial to one that resembles the association one has with a cartel as the family’s finances soar. When his uncle’s lover appears at the threshold of the new, sprawling family home with a tiffin box of his uncle’s favourite red masoor dal curry, he watches and sympathises with the woman as she is shooed away crudely by the matriarch of the household, while the men, including his uncle, simply do nothing and make themselves invisible.

When confronted about the incident by his strong willed, conscientious wife Anita, he seems to imply that he struck a bold stance when he says “I didn’t abuse her.”. He also sits quietly at the dinner table as his family descends to needlessly employing thugs to achieve their various ends, all the while acknowledging that it doesn’t sit well with his sense of ethics. This inertia carries on to his workplace, a warehouse where he occupies the seat of a director and visits only with the express purpose of catching up with his newspaper reading.

The liberal elite, who have benefitted immensely from the structure of contemporary society, suffer from the same strand of hypernormalised inertia. Yet we somehow cling to the idea that we can tinker and whittle away until we reach some sort of amicable utopia. Even when big ideas that directly attempt to topple power make their way to the mainstream liberal imagination (the Occupy movement, for instance), we manage to focus too much on the process of dissent without a tangible vision for the future.

Perhaps the height of this sense of liberal gumption was seen when the Democratic Party decided to run with the slogan “America Is Already Great” in a deeply divided nation just waiting to burst at the seams. Real change will take a lot more than closing our eyes and pretending the big bad monsters don’t exist. They do and they always have under the surface – it will certainly take a lot, lot more than a Lena Dunham Op-Ed, and it will require that the moneyed classes give up the numbing comforts they are used to.

I simply don’t see that happening in my lifetime, so all I can anxiously say is, “Ghachar Ghochar, Ghachar Ghochar”.

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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.

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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.