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The Daily Fix: Pakistan's treatment of Kulbhushan Jadhav adds fuel to a simmering situation

Everything you need to know for the day (and a little more).

The Big Story: Fueling fire

The year 2014 seems like aeons ago now. Back then Prime Minister Narendra Modi, fresh off his massive electoral victory, invited Pakistan Prime Minister Nawaz Sharif along with other heads of state from the subcontinent to attend his swearing-in ceremony. In December 2015, things went even further, with Modi making an unscheduled stop in Lahore, the first visit by an Indian prime minister to Pakistan in more than a decade. The promise of those events, and the hope that an electorally stronger Modi would be better placed to deal with Pakistan, feels like ancient history now.

On Monday, Pakistani military authorities announced that they had convicted Kulbhushan Jadhav, an Indian man who Islamabad claims is an agent of India’s Research and Analysis Wing, and sentenced him to death after a closed-door court martial. India responded by pointing out that Pakistan had offered no evidence, beyond a questionable confession, and had not provided consular access. New Delhi went further, saying if any execution were to actually take place it would constitute “premeditated murder”.

Analysts are clear that the death sentence is a Pakistani provocation. Spies are usually dealt with in the same cloak-and-dagger manner that they operate in. Turning the matter into a quasi-legal proceeding, albeit behind closed doors, and publishing a press release suggests Islamabad wants to send a message. Some have brought up India’s recent actions that have annoyed Pakistan’s biggest ally, China. Those in the know also point to a retired Pakistani Army officer who disappeared in Nepal last week, which rumour mongers in Islamabad would have people believe was a RAW plot.

India and Pakistan were already on edge ever since the Uri attacks in September 2016, which were soon followed up by surgical strikes a few days later – a much-publicised military action by Indian forces, with Delhi claiming it had attacked “launching pads” of militants across the Line of Control. Since then, relations have remained tense, even as the rest of the world around India and Pakistan seems to have become even more volatile.

It may be some time before we know what is actually happening here, and what Pakistan is trying to achieve. In peacetime, spies that have been caught tend to be used for leverage and often become part of quiet deals that are not publicised. That Islamabad chose to go public with its treatment of Jadhav makes it clear that this is a public relations exercise.

But provoking India at at time when local politicians have anyhow been fanning jingoistic flames, while other parts of the world become even more tense, is deeply irresponsible. New Delhi now has no choice but to be vocal and emphatic in its response. Hopefully the clear dangers of going down this path – including what it means for future treatment of Pakistani spies in India – will become apparent to Islamabad.

The Big Scroll

  • Manoj Joshi writes that the death sentence to Jadhav is a clear provocation, something that should not be happening when two countries are not at war.
  • Last year, Cyril Almeida wrote that the capture of Jadhav was aimed at a domestic Pakistani audience to prove to the public that the armed forces are still competent.
  • This was the video that Pakistan released after it claimed to have captured Jadhav.

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Punditry & picks

  1. Arvind P. Datar in the Indian Express, citing the dangers of judicial bans that replace existing government policy, says that the Supreme Court’s highway-alcohol decision should have been left to individual states to tackle.
  2. Prasar Bharati does not need Rs 75 crore for a new propaganda arm aimed at creating an Indian BBC or Al Jazeera, writes Vidya Subramanian in the Hindustan Times, saying it should focus on how to spread awareness within India first.
  3. Mihir S Sharma in Bloomberg points out that the Indian government seems to have lost any enthusiasm or faith it might have had for multilateral free trade agreements.
  4. Never mind a broader conversation about politicisation or deep manipulation, even the basic collection techniques through which India’s data is put together has come under scrutiny, writes Jessica Seddon in Mint.
  5. Snigdha Poonam and Samarth Bansal in the Hindustan Times tell the story of an Indian call centre that runs a massive tech support scam.
  6. An extraordinary student movement is taking aim at the elitism of India’s legal education, and beginning to change the way law works in the country, writes Kavitha Rao in the Guardian.

Don’t miss

Priyanka Vora explains why India’s pregnant women are missing vital ultrasound tests: doctors simply are not mentioning the procedure.

“Despite going to a government hospital, the Mumbai woman did not receive adequate ante-natal care. Healthcare providers including doctors and nurses are expected to give pregnant women information about check-ups and necessary tests.

Doctors said that the 18th week ultrasound which is also referred as an anomaly scan is the most important investigation, especially in India, since abortions are allowed only up to 20 weeks. An abortion is permitted beyond 20 weeks, only when “termination of such pregnancy is immediately necessary to save the life of the pregnant woman.”

The ultrasound procedure done between 18th and 19th week of conception can reveal such abnormalities that can help a woman or a panel of doctors decide whether a termination of pregnancy is advisable. Despite this, doctors said that many women visiting both private and public hospital skip the vital procedure. In most cases, women say that they were not aware.”

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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.