The Need for Better Corporate Health

It was 7  PM in the evening in our Mumbai office. The day was winding down and it had been a hectic day for the sales people. The CEO wanted to review the sales plans and he had asked each sales person to present their targets and plans. We have a reconstituted Mumbai sales team and the CEO wanted to use the opportunity to interact with each sales person and also do a first hand assessment of the talent we had on b0ard. He was done with the junior most team members and now he was  planning to have one final round of meetings with the supervisors to share his views and provide feedback.

As the meeting with the Managers got underway, one of our most experienced sales person, Alvin started feeling a little uncomfortable. Alvin is 36 years old and is a veteran in the industry. He has been working for us for close to 3 years now. Alvin started sweating profusely, was breathing in great gulps and was clearly distressed. He complained of tightness in the chest, heaviness all over and seemed to be unable to keep his eyes open.

As Alvin collapsed no one seems to know what to do. Someone got him down to a car and they rushed him to the nearest hospital. The Mumbai roads were as usual clogged and it took them at least 45 mins to reach the hospital. During this time, there was no one who could provide first aid and everyone prayed that nothing should happen to Alvin before they reach the hospital.

Scary isn’t it? But this is how most offices in India are. There are hardly any provisions for managing an untoward incident in the office. There are no trained personnel, who can provide basic life support till help arrives and there are no emergency protocols defined or practiced, which may help in managing a medical emergency at the work place.

There is no denying the fact that work place health is amongst the most neglected in most corporates in India. With increasing levels of work stress, sedentary lifestyles late nights and weekend business parties, corporate India today offers a lifestyle, which is fast paced and quite deadly. Coupled with pressures at home with nuclear families and live in helps being the norm, life for most people in big cities is a roller coaster and this is taking a gradual toll on everyone’s health.

Lifestyle diseases including cardiac diseases, diabetes and hypertension are catching their victims young and often by surprise and corporate India is just not equipped to handle this.

It is imperative that corporates start paying serious attention to the health of their employees. Annual health checks must be mandatory and should be taken a lot more seriously than now. It would also help if the companies could hire the services of professional counselors, who can interact with the employees regularly and shepherd them through periods of heightened stress either at work or home. There is no harm or shame in having shrinks at the workplace to help employees cope with a crisis that may be lurking round the corner. An organisation must maintain a health register of all its employees detailing their existing conditions, their risk factors, lifestyle choices, allergies, emergency contacts, family physicians et al. This information should be maintained and updated on an annual basis and should be immediately available if required.

It would also be a good idea to train  a few employees in Basic Life Support techniques. I would recommend at least 1 trained person per 50 employees would be a good ratio. Everyone should know that they need to call in case of a medical emergency at the work place. Hospitals in Delhi usually help train employees and they rarely charge a fee. While, I worked in the hospitals, we made a special effort to organise these trainings. Yet, I recall, we struggled to get corporates to allow to conduct these. Most corporates looked upon these as a waste of time and a kind of marketing activity for the hospital happening on their premises.

It would also help if the corporates had a clearly defined emergency protocol and people identified who would coordinate the medical evacuation. In Alvin’s case, we rushed him to the nearest hospital. As luck would have it, this hospital did not have a cardiologist in the emergency, it did not have a cath lab, a 3 D echo any other kind of emergency cardiac support. While, they managed Alvin as best as they could and stabilised him, we were plain lucky that Alvin was not having a heart attack. Investigations later revealed that Alvin suffered from hypertension and had a deranged lipid profile. We also knew he smoked like a chimney, loved alcohol and led a wholly sedentary life. He was under immense work pressure, spent more than 3 hours commuting from Thane everyday and was trying hard to juggle personal and professional life as best as he could.

For him this was a warning sign. His body is protesting against constant neglect and abuse. For the corporate too it is a big red light. We should have known about Alvin’s medical condition in advance. More importantly we should have been better equipped to handle the kind of medical emergency we faced all of a sudden.

This unfortunately is not just our story alone. It is happening all too often in many organisations. We need to sit up, take notice and try to create a healthier and medically better prepared workplaces.

To protect the privacy of the employee, I have changed his name.

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The Apollo Clinics-The Perils of Franchising Healthcare Services in India

I came across a piece co-authored by my former colleague Ratan Jalan in ‘Marketing Health Services’ (Eye on The Indian Market, Spring 2009 edition)of the prestigious journal of the American Marketing Association. I have known Mr. Jalan since he hired me to work for him at Apollo Health and Lifestyle Ltd., many years ago and hugely respect his scholarship and knowledge about the business of healthcare in India. However, I must confess that I do not quite agree with Mr. Jalan’s portrayal of the opportunities in franchising healthcare services in India and his conclusions about Apollo Health and Lifestyle’s successful franchising of the Apollo Clinics.

Apollo Hospitals is one of the largest chain of hospitals in India. It has in its network more than 41 hospitals and manages over 8000 beds mostly in the secondary and the tertiary healthcare space.  I met Ratan in the year 2001, when he was setting up Apollo Health and Lifestyle, which was to get into franchising of the Ápollo Clinics, the primary healthcare services chain, which were supposed to complement Apollo’s large secondary and tertiary care network. These clinics were envisaged as a franchised operations, supported by the Apollo Hospitals group. They were to leverage Apollo’s excellent brand equity and knowledge about the healthcare in India and help franchisees run a profitable enterprise.

The Apollo Clinics were well conceived. The service mix was essentially OPD consultations, a collection centre for pathology samples, radiology services (X-Ray, Ultrasound) and basic cardiology diagnostics (ECG, TMT and Echo). The clinics also had a 24 hour pharmacy and basic preventive health packages were also offered. We worked hard on the look and feel of the clinic (Ratan had Alfaz Miller design the clinic interiors), Ravi Bajaj was to do the staff uniforms, and the clinics were to hire smart and well-trained youngsters to be the face of the clinics. The consultants were to from the local areas and it was thought that Apollo Hospital’s senior consultants will also run their OPD’s from these clinics.

On the business side of things a franchisee needed to invest close to Rs. 20 MN upfront. The business plan included a fixed percentage payout by the franchisee of the revenue that he made. Apollo was to handhold the franchisee through the setting up of the clinic, purchase of medical equipment, development of the software to run the clinic, recruitment of the employees both medical and non medical, and selection of doctors. Apollo was also to provide an exhaustive set of instructions and guidelines on the management of the clinic to the franchisees and it was responsible for monitoring the quality of the services delivered at these clinics.

While on paper the model looks perfect, it has some serious infirmities.

A franchised operation by definition has to be a replication of an existing successful model. In Apollo’s case, they had nothing to show in the area of Primary Healthcare. They used to run a clinic in Mumbai, which they owned. Just about the time Apollo decided to go the franchise route, their own clinic shut shop. It was losing money hand over fist and the management decided to shut it down.

In the franchised model that was now envisaged Apollo had no financial stake. The money was to be put up by the franchisee, he was to bear all the costs including a revenue share with Apollo and it was not clear how Apollo will contribute to bringing in new patients to the clinic. It was expected that Apollo’s name itself will pull in patients. Thus the franchisee was to fend for himself as far as developing the business was concerned. Apollo could have contributed by investing in the brand ‘Ápollo Clinics’ and by forcing some of its leading doctors to run the OPD’s from the franchised clinics. Apollo made lofty promises of investing millions in the brand but just didn’t. As far as doctors were concerned, some feeble attempts were made to get Apollo doctors to attend these clinics but hardly anything materialised. The problem really was that in Apollo system the senior doctors are not paid firm salaries and they work on a revenue share model. Thus, Apollo’s control over these doctors is minimal. The senior doctors with a busy practice had no reason to sit in the newly opened Apollo Clinics, which in any case did not have any patients of their own.

The selection of the franchisees too threw up issues. The franchisees were largely businessmen with hardly any experience of healthcare. Neither did they have any particular love or passion for the healthcare business. I remember meeting and offering franchises to computer hardware merchants, aluminium dealers, a golf ball manufacturer, a real estate player and the like. All of them were driven purely by a profit motive. Some also saw healthcare as a more respectable business for their children. We sold the franchises indiscriminately, (at least in the beginning) to anyone willing to put up the money. A network was thus born that had no glue except the brand name that each franchise shared with the other.

The biggest casualty in all this was of course the quality of healthcare services that each clinic rendered. There was no uniformity as each franchisee left to fend for himself became increasingly desperate for revenue. He hired doctors on his own many of dubious quality, started offering cuts for referrals, set his own prices and started indulging in all kinds of practices that would help him get the extra money that he needed to stay afloat. As most of these franchises were not businessmen with deep pockets, they were willing to cut corners as their very survival was at stake. In-spite of all this many had to close down operations.

Apollo gradually lost control over these franchises. Since, it did not add any value to the franchise’s life he decided not to pay the monthly royalty. Many refused access to Apollo personnel on their premises and are now pretty much operating as stand-alone entities. They continue to use the Apollo name, as that is the only thing, which adds value to their operations.

Creating a franchised healthcare network is fraught with danger. Apollo failed by not first establishing a successful chain of primary healthcare centres of its own. It had no proven learnings in that space and it undertook to make money at its franchisee’s cost. It lost the trust of not only its franchisees, but also of many of its patients who certainly expected a lot better from Apollo.

Pic courtesy The Apollo Clinic website