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The Daily Fix: Will the Centre’s hurry to roll out GST lead to a note ban-like mess?

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

The Big Story: Ready or not

The list of people telling the government that the country is not ready for a rollout of the Goods and Services Tax is extensive. The Opposition has said Indians need more time to be prepared. The West Bengal government has said the Centre should put it off if the systems are not ready. Traders across the country have asked the government to give them more time. The Associated Chambers of Commerce of India, a major industry body, has asked the Centre to postpone it. Even the Centre’s own Civil Aviation Ministry has written to the Finance Ministry asking for the new tax regime to be deferred by two months.

And yet the government is adamant. GST, which fundamentally reshapes the way taxation operates in India by subsuming all local and Central indirect taxes into one rate for each item, is still slated to be rolled out in less than two weeks on July 1. “We don’t have the luxury of time to defer the implementation of GST,” said Finance Minister Arun Jaitley on Sunday. And so, come July 1, India can expect to see a loud launch event, as is customary of this government, that may for once be commensurate with the actual move, which could easily end up as Prime Minister Narendra Modi’s most significant legislative achievement.

What Jaitley did not explain when he said “we” do not have the luxury of time, is that the we here refers to the Bharatiya Janata Party as much as it does the country. It has been conventional wisdom for some time now that if the government is not able to implement the new tax regime this year, it would likely defer it to 2019. This is because many expect both the rollout of the new taxation scheme to be both messy and potentially lead to inflation, both of which could affect the prospects of the party with general elections due in May 2019.

There are other reasons for the hurry as well, but the electoral imperative is inescapable. It is in this light that the ASSOCHAM letter in particular is important to pay attention to. The organisation said that there were major glitches in a test run of the IT system last month, which led to major revisions, prompting the body to express doubts about the system’s readiness. This is doubly relevant because of concerns about the GST Network, a special purpose private firm that was supposed to build the IT backbone of the new regime. Questions have been asked about why a private firm is running a crucial government initiative, with the BJP’s own Subramanian Swamy being one of the biggest skeptics.

The hope of course is that the rollout on July 1 will go smoothly and the country will not face the kind of distress that was forced upon it because of the disastrous implementation of Modi’s demonetisation effort last November. So many people are convinced that the rollout will be chaotic that anything short of a complete mess might now look like a success, which is equally problematic. The GST is a huge effort, one that reshapes the Indian Union itself. If we go by the government’s promises, the launch – accompanied by a two-month relaxation in filing – should go well. But if it is less than smooth, it will be important to come back to representations like ASSOCHAM’s and question whether electoral imperatives overrode an actual evaluation of this massive project.

The Big Scroll

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Punditry

  1. “It would appear that the GST Council has succesfully imported a technique from visual arts and introduced the “male gaze” into the taxation regime,” writes Tara Narula in the Indian Express.
  2. Usha Rai writes in the Hindustan Times on how Telangana’s new pension for single women is a welcome move even if the rub is in the implementation.
  3. “Data releases since late May have been suggesting that demonetisation may have had insidious second-order impacts which are yet to be fully understood,” says a leader in the Hindu Businessline.
  4. The Panama Papers scandal is not only an ideological concern for the Pakistan Tehreek-e-Insaaf, writes Umair Javed in Dawn. It is also the fuel that’s keeping the party in the race, even as the deck is stacked in favour of the ruling party.
  5. Kapil Sibal, the Congress leader and former union minister who oversaw and defended the passage of Section 66A of the IT Act, writes in the Hindu explaining how the new cattle trade rules constitute a muzzling of free speech.

Giggle

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To avoid sensory overload, Vedant has tried to escape on several occasions. Being in an unfamiliar place, caused him to have accidents and his Pica would kick in when he was left unattended. Pica is the persistent eating of substances such as dirt or paint that have no nutritional value So, my husband and I decided to split time. While I spent the first 15 minutes keeping an eye on Vedant, my husband could hang around with his friends and then we switched, like police patrol. This strategy has worked really well for us. We are able to catch up with our friends and also not let our son feel insecure or unattended.  

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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.