CASE STUDY
E
The Right
Approach
The management, irrespective of size and scale are
confronted with unprecedented and unwarranted
situations and are therefore left with no choice but to
abide by public opinion. This brings forth resentment
amongst the employees, who, therefore challenge the
management head-on, resulting in an all-out war. With
the management and the employees at loggerheads,
the very structure of the organization becomes
susceptible to extreme damage.
- BY JYOTI PRIYADARSHINI SHRIVASTAV
54 N August 2017
stablished under a trust,
Dhanvantri Shiksha Sansthan is
an educational institution that
came into being in 2000. Unlike
several other institutions that were
mushrooming in this age of private
education, this institution had a very
good beginning. In the year it came into
being, the only programme that was
rolled out was the nursing course, and,
against a sanctioned student strength of
100, only 30 enrolled and the
management was able to get five faculty
members. After about a year, the
institution managed to develop its own
infrastructure, and, came forward with
its own campus, library and labs. The
hostel was also inaugurated by the Chief
Medical Officer of the District.
In the second year, several new
courses like Diploma in Physiotherapy
and B.Sc. MLT etc. were introduced, and
these, in turn, resulted in a heavy rush
for admissions. By now, the strength of
the faculty had risen from five to twenty.
The management was planning to
introduce some more courses, and,
become one among the premier
institutes in the field of medical education
and health care services, since it could
now utilize the multifaceted resources
from the college, apart from the interns
www.humancapitalonline.com

in the various programmes, as this near
rural area had very deficient medical
facilities. In fact, no medical institutions
and health care facilities were available
in a radius of 500 Kms.
Now in its seventh year, the
institution was already running six
programmes including MBBS, which
was started during the second year the
institute came into existence. The Out-
Patient care wing was witnessing great
rush, while the in-patient facilities still
stood restricted to fifty beds. The
gynaecology and the general medicine
departments were getting a great
response, but, the cardiac and the
surgery were still unable to get the
required numbers of patients.
Meanwhile, the management was
confronting a serious problem due to
frequent infighting incidents among the
senior staff. The Management had also
considered sending some of its staff on
development programmes. Three of
the departmental heads, the Head of
Lab Technology programme, the Head
of Nursing College, and, the Dean,
Paediatrics had already been sent for a
programme conducted by a premier
management institute, though, nothing
much could be achieved out of this, and,
bias, sabotage, indiscipline continued
unabated. The management had tried
to counsel them on several occasions,
and, at times, acted as an arbitrator over
various issues, but things remained the
same. The Nursing Principal could not
even see eye to eye with the Dean of the
Medical College, and, it created
problems in the In-patient services
many a times, since these were virtually
manned by the interns from the nursing
college. The Lab Technology wing was
no better, and, there were several
instances wherein the interns in the
MBBS programme were asked to
conduct the tests and give the report.
This year too, the applications for
various programmes outnumbered the
availability, and, were thrice the
sanctioned strength in other
programmes. For the MBBS
programme, matters were sensitive
since the government had taken the
admission procedure under its control,
since, ten Medical colleges had come
up in the State in the last few years, and,
it was the course fees that was the
apparent paradise for the institutions
and the free market. If the government
exercised too many controls and
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CASE STUDY
undertook the admission process itself,
Dhanvantri is likely to suffer huge losses.
Dhanvantri was still contemplating
strategies to solve its crisis, when it was
confronted with a new problem.
On the night of 5th December, at the
emergency ward, Dr. Vikas Mohan, a
senior resident doctor on duty at the
hospital was beaten up by two young
men, the family members of a patient,
Sheela, who was brought to the hospital
in a very critical condition. The lady who
was pregnant, had met with an accident
while she was crossing the road with her
seven year old daughter. The foetus of
the pregnant lady had also died, and the
daughter, Radha, had suffered severe
injuries, and, had been brought to the
hospital. The lady had sustained severe Jyoti Priyadarshini Shrivastav is
injuries in her abdomen, and, had also
a Partner in Salahkaar The Consultants,
severely injured her limbs. Her legs were
a law consulting firm based in Haldwani,
paralyzed, and, it appeared that she
Uttarakhand. She has an experience of
would be unable to move them again.
over a decade in the field of academics. A
Manilal, the patient's husband was asked
gold medallist in LLB, Jyoti has done her
by the hospital to deposit one lakh rupees
PhD in labour laws from the Business
towards the necessary treatment of
Administration Department of the M J P
Sheela and Radha. Manilal who had
Rohilkhand University, Bareilly. She can
managed to arrange fifty thousand rupees
be contacted at jyotipriya.s@gmail.com.
from family and friends, requested that
he be given more time for arranging the
remaining fifty thousand rupees since the local television channels. The TV
he had been get hold of the full amount channels were playing the breaking news
owing to the shortage of currency in the as "a poor family unable to pay the
banks. He pleaded that the necessary hospital fees due to the non-availability
treatment be carried out to save the lives of cash due to shortage of cash was
of his wife and daughter. However, the deprived of the medical assistance and
hospital staff explained their inability to had lost a child at a private medical
proceed with the treatment without the college hospital asked to go to a
full money being deposited, and, said government hospital for treatment of
that Manilal was free to take his patients their other patient who had been
to a government hospital if he did not seriously injured in an accident
have the required deposit amount. enraged by this they had beaten up the
Meanwhile, the family was informed that doctor on duty".
the little girl Radha could not be saved An emergency meeting of the
and had succumbed to injuries. The two management of the hospital was called
men, Manilal and his brother, on hearing early next morning and, subsequently,
about the death of the daughter, lost in a hurriedly called press conference,
their patience and started hurling abuses the hospital administrator announced
at the staff who were present. They were that the hospital would provide free of
asked to keep quiet or move out of the cost treatment to Sheela and that Dr.
place, and, this enraged them even Vikas Mohan stood suspended with
more. Dr. Vikas Mohan, who was the immediate effect.
resident doctor on duty, was informed Within an hour of the
of the scene and the ongoing shouting announcement, the doctors at
and abusing by the patient's relatives at Dhanvantri lodged a protest and wore
the hospital reception. Dr. Vikas tried to black badges to express their anger over
explain the circumstances to Manilal, but the suspension of Dr. Mohan. They also
Manilal had by now become violent, and, demanded that necessary protection be
he and his brother ended up beating Dr. provided to the doctors on duty from
Mohan. such violent outbursts, failing which they
Overnight, the news was on air on would resign en masse.
August 2017 N 55
CASE STUDY
Analysis By Denise Braganza
I
t appears that an unplanned and
an unstructured expansion
produced an array of potential
threats to Dhanvantri Shiksha
Sansthan (DSS). The quest by the
Management was to offer more
courses given the strategic location in
terms of geography coupled with the
ambitious goal of rapidly seeking to
turn DSS into a premier institution by
leveraging its resources. However, the
failure to fortify the edifice with
professionally competent talent capable
of building a strong foundation of
systems and protocols proved to be a
precarious aberration. Crucial key
nuances seemed to be omitted; such
as good hire decisions and nurturing
administrative and leadership talent.
Frequent conflicts percolated deep
creating a climate of dissent and
division. Patient care suffered as interns
Denise Braganza is the Head- Human
Resources, Hinduja Healthcare Surgical,
Khar. She carries an experience of over
20 years in Human Resources and
Training and has worked with MNC's like
HSBC and Franklin Templeton. Her core
competency areas are Behavioural
training, Performance management
and Leadership Training. She is also
practicing as a Clinical Psychologist.
56 N August 2017
from the nursing college were forced
to take on patient care duties outside
their purview.
DSS had a competitive edge as no
other Institution of repute was within
a radius of 500 kilometres, and, they
had multifaceted resources. But, this
did not prove advantageous as the
Institution was not supported with
robust systems and controls apparent
from the inability to maintain basic
standards in its day to day operations.
The approach by the
Management to deal with
serious inter-departmental
disputes engulfing the
Institution were mere quick-
fix measures inept of
resolving issues of
indiscipline, sabotage,
conflicts and unqualified
staff performing duties.
Training or occasional
arbitration between
departments proved
ineffective to douse burning
issues affecting the Institution.
The incident of 5th
December was a serious road
accident involving a pregnant
lady and her young child at the
emergency ward. Ideally, doctors and
by extension, the Institution could not
deny treatment in case of loss of life
or limb (hands, legs or sight) in a Road
Traffic Accident. To save life and/or
limb of the patient is enshrined in the
code of medical ethics. Thus, the
Institution's refusal for treatment to
save lives by insisting for nothing less
than a sum of one lakh rupees to be
deposited before extending treatment
was against medical ethics.
The delay resulted in the child
succumbing to her injuries without
receiving medical attention. Despite
this tragedy, the staff showed extreme
apathy towards the family experiencing
shock over the loss. "Asking the family
to move out" caused further anguish
resulting in violence. The Senior
Resident's late arrival on the scene
coupled with his inability to penetrate
the emotionally volatile situation
reflects poor communication and the
lack of empowerment to take decisions
in crisis situations. The attempt by the
Management to save the Institution's
reputation by suspending the Resident
led to a backlash by the doctors who
felt resentful and abandoned by the
Management. In conclusion, the
incident was able to expose a vista of
deeper issues as mentioned above the
much needed immediate attention.
Recommendations
An immediate inquiry by the
Management before suspension should
have been mandated to ensure fair
practice. For the long term progress
of the Institution, it would be essential
for the Management to have a master
plan for navigating expansion and
having strong leadership to steer the
Institution to the desired destination.
The Management's focus and
investment of time should be on
building a competent team of
professionals, who in turn, would
formulate and implement sound
mechanisms, strong controls and high
operating standards.
The Management must clearly
define the values, mission, vision, and
culture of the Institution and
communicate the same in an effective
manner. Promoting internal
communication, collaboration,
standards and protocols within the
Institution should be a priority, and,
including it in staff performance and
evaluations would ensure that it is
implemented and realized. Training as
a continuous endeavour including soft
skills and medical ethics would equip
and prepare personnel to handle
situations. A well trained and a
competent team could have
circumvented the crisis and saved the
Institution from bad publicity and loss
of life.
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Analysis By Rajesh Jain
T
he case of Dhanvantri Shiksha
Sansthan (DSS) is indeed very
intriguing. The Institute
seemingly did well in the
beginning as they focused on only the
nursing course and created a nice
infrastructure very soon. They steadily
added products and services and
strengthened their market position and
revenue streams in about seven years.
They were very well placed in the
market because there were no medical
institutions and health care facilities
available in a radius of 500 kms.
As the organization grew in size,
several instances of internal and
interpersonal issues came into the fore.
There was a time when people stopped
recognizing the bigger picture and
started working for personal benefits,
which gave rise to complexities. As a
strategy, the management decided to
make each business vertical a profit
centre. From vertical profitability, they
aimed their focus at transactional
profitability, and somewhere, the
'service attitude' and long term view
got diluted.
All the organizations are susceptible
to crisis. DSS got into a mess as soon
as a poor family which was victim to
a road accident entered their hospital,
and, asked for subsidized treatment.
DSS, unprepared to handle such an
incident, not only mishandled the
situation, and instead, converted an
opportunity into a crisis. Thus, they
ended up earning a bad name and
losing employee confidence. It is
important to analyse this scientifically
and arrive at the root cause rather
than pointing out at the symptoms.
The '5 Whys' technique
Let us look at the last situation as per
the case description. "Within an hour
of the suspension of Dr. Mohan, the
doctors at DSS lodged a protest. They
also demanded that necessary
protection be provided to the doctors
on duty from such violent outbursts,
failing which they would resign en
masse."
Why did the management sack
Dr. Mohan?
He was sacked because of the adverse
media coverage of the incident in which
a young girl died. Dr Mohan was unable
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to handle the situation and could not
convince the aggrieved family.
Why could Dr. Mohan not handle the
situation?
He could not since by the time he got
into the situation, it was late. The young
girl has already died because the
hospital did not treat her in time.
Why did the hospital allow the
situation to come to the tipping point?
This happened because of the
insensitivity on the part of the staff.
They could not visualise that lack of
treatment could lead to a loss of life
which will create issues of a serious
nature.
Why was the staff insensitive?
The intended value system and the
culture of the hospital was 'profitability
first'. Everything was linked to profits.
No one could think from the service
angle or from any other angle and tried
to help the accident victim. The
Hospital has been inculcating
behaviours, which were not service
oriented. There was an extreme non-
collaborative environment within
different verticals which in itself cannot
breed a service-oriented culture.
Why 'profitability first' culture was
prevailing in the hospital?
The hospital's business model is such.
The hospital management is looking
for profits from all the verticals
separately and creating internal
competition and non-collaboration. In
a situation where the lack of trust
amongst various components of the
organization exists, people in the
organization will treat the customers
very badly.
Hence, the root cause is the
organization's culture which was
hindering the ability of the organization
to be able to 'think whole' instead of
'thinking part'. This can only be
achieved if the organization is
collaborative, solution oriented, service
oriented and trust prevails amongst all
the stakeholders. Such organizations
collaboratively work towards solutions
and convert problems into
opportunities rather than passing the
buck.
Unless the head of the organization
and the top management decide to
build such a culture in DSS, they will
continue to face such situations in the
CASE STUDY
Rajesh Jain is HR Head -Corporate &
Financial Services, SREI Infrastructure
Finance Ltd. He is an industry expert with
27 years of experience in businesses and
functions across diverse sectors such as
Energy, Power and Document technology,
and Services. Rajesh is an experienced
examiner of Malcolm Baldridge Business
Excellence Model, is a Six Sigma Trainer
and a certified trainer of the Lominger
Competency Model.
future as well. The hospital has
invested in infrastructure and resources
including acquisition of human
resources. However, they have failed
to invest in the right kind of culture to
run a good hospital and an institute.
Profits are important, but, profits can
be sustained only if the right kind of
service levels are achieved and
maintained. The media will make
everything sensational and one can
manage to a limited extent.
Imagine a situation where the
Hospital Management had realized the
importance of a service-oriented
culture. HR function along with the
CEO and the heads of the verticals had
identified the critical behaviours
leading to a collaborative and a service
oriented culture. The staff would have
been sensitive to customer needs, and,
in a situation of emergency would have
at least treated the patient and her
family in an empathetic manner. Also,
'the crisis happens'; historically
organizations who are united and
collaborative come out of it more often
than the others.
August 2017 N 57
CASE STUDY
Analysis By Ravi Mishra
A
t times, when an institution
like Dhanvantri Shiksha
Sansthan (DSS) witnesses
growth of an unprecedented
nature, it is unable to evolve to maturity
in a structured manner, and, this
resultant mayhem is apparent. DSS
started with five teachers and in only
one year i.e. the second year, it grew
fourfold with many new courses
including MBBS. Apart from other
aspects of success, one very critical
factor is its competitive advantage was
in terms of its location, as there was
no other established medical facility
available in the periphery of 500 KM.
Great organizations are built on a
structure, which works like a steel
frame that demarcates responsibility
and accountability in a guided form to
achieve the purpose with coordinated
effort. What we find here is that due to
lack of a proper structure, the Nursing
and the Medical departments are not
working in line to meet the
organizational objective.
Solution Vs Mitigation
One of the most important reasons of
disharmony in DSS is its casual
approach with regard to people related
issues. It can be noticed as mentioned
below: -
G Internal fighting in cross functional
employee teams. The Management
did not get into the root cause to
mitigate underlying factors
responsible for it in a systematic
way through the Human Resource
function, or, external expertise as
against resorting to a short term
solution to resolve through
arbitration.
G They nominated their senior
employees to attend class room
training for their development in a
Management Institute. It is evident
that there has been no significant
impact of such training at the
workplace. This is as simple as
treating a patient without knowing
the disease. If they were well versed
with the principle and impact of
the 70:20:10 learning intervention,
and, it could have been avoided to
use the weakest tool that impacts
only 10% of objective development.
G It is indeed a piteous situation when
a doctor is bound to work as a lab
58 N August 2017
chemist to ensure that the patients with minimum hindrances and
do not suffer beyond a point. It is conflicts.
systematic failure in the 4. Effective space to Human Resource
organization that reflects anarchy function to discharge its role.
at the cost of the patient's life. 5. Clarity of authority with clear
G When Manilal assaulted Dr Vikas description of role and
Mohan, the hospital administration responsibility at every level.
was unable to handle the situation. 6. Collect periodic feedback from all
Firstly, they failed to control the stake holders such as employees,
emergence of the incident, and customer, patients, vendors and
thereafter, failed to address the suppliers etc. so that issues that
media in an appropriate manner. impact the institution can be
Ravi Mishra is the Regional HR Head - Birla Carbon, South Asia and Middle East.
He has worked in diversified organizations such as Nicholas Piramal, Mardia Group
of Industries, Aditya Birla Chemicals, and UltraTech Cement. Ravi has good exposure
of working in a cross cultural environment, with capabilities of building teams and
understanding business perspectives, linkages and strategic orientation with regard
to people management.
This portrayed a very negative addressed timely and build
image of the organization, and in confidence in the mind our
particular, the medical facility and employees and other stake holders
patient care. that this organization stands to its
commitment.
Building an Institution and its DSS should learn from history that
Sustenance many organizations have grown either
DSS, if keen to establish themselves as by default or by design, and, many a
a great institution, must engage an times by virtue of both. Once an
expert consulting agency who can be organization has attained a certain level,
of assistance in the following: - it is more challenging to sustain, where
1. Chart out the vision and mission of every decision counts, if it not taken
the organization. timely. We have numerous examples,
2. Create an environment where such as Kingfisher, Air India, Union
every employee from the bottom Carbide, Sahara, Enron, WorldCom etc.
to the top should own the vision So, it is high time for the institution to
and mission as shared values in put its sincere efforts to address
their profession. issues, rather than fix problems,
3. Prepare the organizational before it is too late. Leadership is a
structure that addresses the issue responsibility and not an adventure
of relatedness to support work flow for the authority alone.
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