Civil Services Day: Is India’s steel frame really rusted?

Contrary to popular perception, bureaucracy isn’t all about incompetence and corruption.

After Lord William Cecil was made her secretary, Queen Elizabeth I advised him thus, “This judgement I have of you that you will not be corrupted by any manner of gift, and that you will be faithful to the state and that without respect of my private will you will give me that counsel which you think best.”

Thus was born the concept of an unbiased, disinterested and committed civil servant. Over four hundred years on, it remains the guiding principle of civil services in many countries of the world, including India.

The Indian administrative system was founded by the British East India Company. Although the company’s officers were primarily tasked to look after and further its commercial interests, they did ensure some system of governance and justice to the people under their control.

In the British administrative system, based on the recognition of the importance of revenue and magisterial authority, the civil servant, aided by a finely evolved legal system, strove without temptation of reward to administer a foreign people in the name of God and country, or so he was supposed to. In The Men who ruled India, Philip Mason described a quintessential British civil servant thus: “In the public Character, whatever Calumny and Detraction may say to the Contrary, he is minutely just, inflexibly upright and I believe no Public Service in the whole world can evince more integrity.”

The civil servants spread out, imposing law and order in a land prone to feudal excesses and everyday anarchy. The power of the civil service was enhanced when, in 1798, Governor General Lord Wellesley reconstituted his office and created the post of chief secretary, who was vested with the authority to rearrange different departments of the government as he deemed best for “proper conduct” of business. The first chief secretary, George Hilaro Barlow, did not administer each department, but by virtue of his general authority and acting as he did on behalf of the governor general he was held to be in overall charge of the administration. This system continued until power was transferred from the British East India Company to the British Crown in the wake of the First War of Independence in 1858.

“Be that as it may, the fact is that the permanent civil service provides the steel frame that holds this country together. These men and women go to distant parts of the country and put in place systems for governance, and law and order. They represent the face of the government to the citizens of the country.”  

Since administering India was now the direct responsibility of the British parliament, the administrative machinery put in place by the company was formalised as the Indian Civil Service, which was headed by the Secretary of State for India, a minister in the British cabinet.

The governor general, and later Viceroy, became the direct representative of the Crown in India and was given authority over all civil and military affairs.

In the provinces, the governors were given extensive powers for administration, and under them, the office of the chief secretary came to enjoy a pivotal position. As the author Philip Woodruff observed: “The Chief Secretary was the channel through whom the orders of the government were conveyed to the officers. He was traditionally the source of posting (orders of officers); to most district officers, he was, in fact, the government.”

After Independence in 1947, the Indian government, learning the complexities of governing a vast and diverse nation, modified the hierarchies in the administrative set-up, drafted new rules and procedures, and reengineered processes to ensure it best served the interests of the people. The Indian Civil Service thus became the Indian Administrative Service.

Selected on the principle of competition and merit, the young officers of the Indian Administrative Service became the face of the government and worked to carry out its developmental programmes while ensuring peace and tranquility.

Seventy years on, though, the question is being asked whether this apparatus set in place just after Independence, and based on the colonial systems of administration, is still relevant. The bureaucracy is held as being primarily responsible for many of the ills plaguing this country. Be that as it may, the fact is that the permanent civil service provides the steel frame that holds this country together. These men and women go to distant parts of the country and put in place systems for governance, and law and order. They represent the face of the government to the citizens of the country. As they grow in experience and seniority, they are called upon to help in policy-making and supervision. They provide sage advice to their political masters, are rarely obtrusive and often work in anonymity. It would not be wrong to say that the fabric of governance hangs on their shoulders. Of course, there are some people in the service who sully the image of all civil servants.

Governing a country as vast and diverse as India is maddeningly complex. Both our political leadership and bureaucracy, therefore, must be sensitive to the needs and aspirations of different sections of the society. Everyday governance is a tedious task; it is slow, backbreaking and endless as any assistant engineer or district collector will testify.

It is to the credit of our civil servants that despite their many failings – especially in ensuring delivery of services at the last mile – they keep this country going. This Civil Services Day on April 21, let’s celebrate their spirit and determination.

CK Mathew is former chief secretary of Rajasthan. He heads the Public Policy Research Group at Public Affairs Centre, a think tank based out of Bangalore.

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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.