Book review

Why India’s universities must move from ensuring employment to creating empowerment

This collection of essays begins the daunting mission of exposing the culture of ‘mediocracy’ in higher education.

While the architecture of knowledge is changing globally, India languishes in a historical bid to decelerate its educational system – especially university education. Subpar secondary school teacher-student ratios, followed by unskilled or jobless degrees, a promised but long-pending revamped national education policy, hundreds of thousands of posts lying vacant in central and state universities, ritual exploitation of ad hoc faculty members even in the metropolitan cities, historic lows in the budgeting for education as a percentage of the GDP, shutting down of nearly 1000 engineering colleges across the country, and political leaders of fringe groups clamouring for non-western or Vedic education, are merely a few instances of the plague.

Of course, the colour of the cat is not a problem as long as it catches the mice. The problem is there are just too many grass-eating cats in the fray.

Not reforms but reformation

A new book on higher education and educational reforms, The Future of Indian Universities, makes all the right noises in this direction. Edited by C Raj Kumar, it is an anthology of 19 papers from a conference held at the OP Jindal Global University (JGU), in March, 2017. The book may at once be a treasure or Pandora’s box. Designed to deconstruct, disrupt, and “dynamise” stagnant notions of higher education in India, it is the only volume in recent history that deals with the subject of the university and its future – with special focus on administration.

One remembers the remarkable contribution of the Jawaharlal Nehru University in the form of the nationalism lectures, which became the book What the Nation Really Wants to Know. The Future of Indian Universities amplifies the focus to the bureaucratic problems of university education and administration, and pursues that goal unflinchingly.

Raj Kumar – educated at Oxford, Harvard, and Hong Kong, with stints at the United Nations, and now the founding vice chancellor of JGU – and the authors in this volume have ensured it is a rewarding work. The contributors to the book are Pawan Agarwal, Kanti Bajpai, Carol M.Bresnahan, Sreeram Chaulia, Yugank Goyal, Barbara Harriss-White, Sital Kalantry, A Francis Julian, Stephen P Marks, Shailendra Raj Mehta, NR Madhava Menon, YSR Murthy, Indira J Parikh, Alice Prochaska, Prem Nath Raj Sinha, Anamika Srivastava, R Sudarshan and Shiv Vishwanathan.

The book is dedicated to the former President of India, Pranab Mukherjee. Even so, it does not shy away from highlighting Mukherjee’s own “fashionable” espousal of academic values, not to mention the academic “mediocracy” perpetuated, willy-nilly, by other political leaders. Since the book was fondly released by the former President during his final days in office, one presumes it has his blessings – as any work of governmental or legislative criticism should for globally recognisable higher education to become a practical objective in India instead of remaining a theoretical adventure for the upper echelons.

Kumar highlights the lack of incentives for research, corruptible mechanisms for disbursal of funds, overall mediocrity in institutions of higher learning, bureaucracy and lack of proactive measures by the MHRD, socio-political excuses for low global competiveness, lack of autonomy for emerging universities and special educational zones, and the dichotomy between public and private universities despite the fact that the latter are privately governed and funded institutions. Sensibly, he adds that it is not as if Indian universities perform especially poorly, but that they lose relevance internationally, being unable to respond to global transformations. Harriss-White’s essay is especially pertinent in this regard, with her proposition of a “fourth culture” of universities, where private interests are geared towards enhancing and empowering public utility in education.

Beyond the ancient and the modern

Vishwanathan historicises how the institutionalisation of mediocracy led to the decline of the cosmopolitan university (as envisioned by PC Roy, JC Bose and R Tagore), and educational institutions in turn became cultures of employment rather than of empowerment. Despite its gratitude to the professed overnment, the book makes no effort whatsoever to curry favours with its leaders.

This refreshing stance is most strongly seen in the essays by Raj Kumar and Murthy, who criticise piecemeal reforms and statutory regulations, by Mehta and Sudarshan, who underscore the tripartite divorce between public policy, policy education and the public, and by Bajpai, who asserts that leaders who have left Indian universities stolidly at the bottom of global rankings have no moral right to censure elite colleges or ranking methodologies.

While Menon highlights the dangers of the elusive “demographic dividend,” Agarwal provides a series of recommendations to reap this dividend through improved educational governance. It is interesting to note the growing margins by which female students in urban higher education outnumber the males – even as more graduates than ever before are unemployable.

Indian higher education is also afflicted by fake journals and plagiarism, much of it owing to the irrational pressures of publishing, and the unutilised internet expansion in South Asia. This is highlighted by Marks. At the cost of repetitiveness, almost all the contributors argue for greater autonomy of private universities. Srivastava’s caveat comes in handy – that with growing corporatisation of education it is crucial not to lose contact with social justice. Another caveat, from Goyal, is that of the unprecedented surplus in knowledge production today – how global knowledge production surpasses the data of all the libraries of the world.

While the volume talks of the dire need for funding for publishing research and incentivising it for faculty promotions, it is a timely reminder that more than production, today, knowledge requires sharing and integration into the basic curricula and social life – rather than simply having more Indian engineers wanting American jobs, as Bresnahan points out.

One hopes that the book will be able to see itself translated into practical amendments, especially with regard to academic autonomy for universities, discerning and more meritocratic subsidisation of research and higher education, legislation for special educational zones, and of course, more socially relevant curricula across universities and disciplines. The flaws of the book lie largely in its repetitive petitioning for autonomy – one that perhaps highlights the effects that state and central bureaucracies have on the functioning of a private university, or even a public university, for that matter.

Another flaw is in the organisation of the book, emboldened especially in the end. Chaulia’s notions of Gandhian self-reliance and sustainability in education could have been further developed towards a topical conclusion to the book. They are, instead followed by a non-sequitur – an essay on the need for clinical legal education in India, appendices containing Mukherjee’s vision for the future university, and congratulatory remarks to the organisers of the conference held in March. Here the book ends, abruptly.

After nearly five hundred pages of thickly footnoted and insightful recommendations, we are back to square one with the question: who will implement these. Will it be left to these nineteen professors who made this volume possible?

A palpable exclusion from the book is the growing onslaught on freedom of speech, liberal university culture and political responsibility of the student community – especially since the volume is dedicated to Mukherjee, who is a champion of these causes. Notwithstanding this, the book begins a daunting mission, that of disrupting prevailing views such as those which state that Indian higher education is highly successful, or that its future depends on greater political intervention. As more and more evidence comes in to comprehensively rubbish such claims, one worries if the Centre’s push for ancient heritage education – even in school curricula – is the best way forward. The Future of Indian Universities has possibly paved the way for critiquing government policy in education with anti-governmental gratitude.

The Future of Indian Universities, edited by C Raj Kumar, Oxford University Press.

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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

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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 marketing team and not by the editorial staff.