Anything that moves

The viral video by BSF Constable Tej Bahadur Yadav demonstrates the futility of the note ban

The soldier's Facebook posts backing demonetisation expose what he, like millions, failed to understand – black money and the cash economy are red herrings.

Border Security Force Constable Tej Bahadur Yadav, who on Sunday uploaded videos on social media complaining about the poor quality and quantity of food provided to soldiers at border outposts, is no opponent of Prime Minister Narendra Modi, judging by his Facebook feed. He appears to have joined the social network three years ago, but produced no public posts before a burst of activity beginning on November 6, 2016. It consisted mainly of political and patriotic forwards, including a number of images targeting Sonia Gandhi and Rahul Gandhi. On November 7, he posted an image of Sonia Gandhi lamenting that she would have to return to being a bar dancer in Italy since Modi had destroyed her India plans. The next post, dated November 10, is a little ironic in retrospect. It is an image of two jawans making chapatis with the legend, “People eat butter chicken and betray the nation; it takes a jawan to eat scorched rotis and die for the country.”

Next come cartoons and news items favouring the note ban, forwards from organisations such as PM Modi Fan Club, satirical images directed at Delhi Chief Minister Arvind Kejriwal and his West Bengal counterpart Mamata Banerjee, Haryanvi jokes, recipes for home remedies, celebrations of cows and (separately) jaggery, and pictures of Yadav himself, first holidaying with his wife and son, and then back on duty. Finally, out of the blue, we have his filmed protest against ration pilferage and, as I write this, an appeal from his wife saying she hasn’t been able to contact him since his videos went viral.

Yadav’s post exposes what he, like millions of others, failed to understand about the note swap plan: Black money and the cash economy, targets of the currency ban, are red herrings. The real damage to the country’s health is caused by corruption. The generation of unaccounted wealth is just one symptom of that disease. The note swap made a marginal, temporary difference to the symptom, and none at all to the underlying condition.

I have acquaintances whose business plans are stuck because officials will not clear files until liquidity returns to the system and they receive their cut in new currency. At the other end of the spectrum, a youth I know who received an apprentice’s job in a shipyard was denied a caste certificate by the tehsildar of his village till the boy managed to draw enough money to pay him off. No doubt, millions of such stories can be told about the eight weeks since the government’s demonetisation announcement, given how the machinery of the state has evolved to maximise the short-term gains of government officials who have power over the public, or even, as in the case of Tej Bahadur Yadav, over fellow government employees.

Transparency needs

The note ban, far from stamping out networks of malfeasance, has only spurred the creation of new ones. The government makes a show of raids on those holding inordinate amounts of new notes, but since the organisations responsible for cracking down on such crimes are as corrupt as any other government department, it is unlikely that they will accomplish anything substantial beyond the generation of a few headlines.

The government’s attempt to make all transactions amenable to scrutiny involves not just a push towards banking and digital mediation but an effort to put the state itself at the centre of such transactions. The greatest exemplar of this is the BHIM (Bharat Interface for Money) app linked to Aadhaar numbers that Modi’s blue-eyed boy Amitabh Kant, the chief executive officer of Niti Aayog, believes will make credit cards and digital wallets redundant. I have a feeling, based on initial reports, that BHIM will be about as successful as former Congress minister Kapil Sibal’s pet project, the Aakash tablet, which was supposed to revolutionise low-cost computing in India.

The reputation of the Reserve Bank of India has never been so low, its independence seemingly compromised, its credibility damaged by the numerous U-turns taken during the process of demonetisation and remonetisation. Unsurprisingly, a rumour is doing the rounds that the new Rs 2,000 notes are only a stopgap, shortly to be eradicated in a new purge. A belief in the temporariness of the new currency might lead people to avoid hoarding the notes, but that doesn’t mean they will gravitate to the government’s solution. More likely, they will take further recourse to precisely those shadow networks the state wants to eliminate, buying hard currency in the grey market, and further eroding the value of the rupee.

Hawala has become a bad word in our time, but is a trust-based system that for centuries has transferred money efficiently across vast distances in South and West Asia, helping commerce through the largest continent and in parts of Africa. It remains the cheapest way for workers in the Gulf to send their hard-earned money home. If the government wants trusty systems like hawala eliminated, it needs to first demonstrate its own trustworthiness. To begin with, it must take legislative and executive measures to make its employees more accountable. If the government desires complete transparency in private transactions, it must first become more transparent itself. It ought to build on the progress engendered by the Right to Information Act instead of stymying queries and carving out exceptions.

Halfway through its term in office, the Central government has taken no steps towards either greater accountability or greater transparency. This fact will be driven home as the game of smearing the whistleblower jawan and passing the buck takes off in earnest within the Border Security Force.

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.