TAKE AS DIRECTED BY YOUR DOCTOR!

By Aarti Narang

Many of us stop taking our medicines before we should. Why playing doctor can be a dangerous game.

A colleague of mine wants his story told. Like innumerable people in Mumbai, he got conjunctivitis during the monsoons last year. His GP prescribed a week’s course of antibiotic drops. Antibiotics are used to fight bacteria, my colleague was aware, but after he read a newspaper report, quoting a city doctor who said that the conjunctivitis epidemic was viral—a claim that was never proved, my colleague now says—he stopped the antibiotic drops three days into the course, bought an antiviral ointment and used it in his eyes without consulting the GP. “I’ve had conjunctivitis on two earlier occasions,” says my colleague, “and they never lasted more than four or five days. But this time it wasn’t going away even after ten days.”

“If you discontinue an antibiotic, even if all the symptoms disappear, and not complete the prescribed course, chances are the infection won’t be eradicated completely. And if you have a rebound, the regular dose or same drug may not work,” says Raj Vaidya, chairman of the Indian Pharmaceutical Association’s Community Pharmacy Division. “And for chronic conditions like diabetes and blood pressure, you have to keep taking the medicines to keep the disease, which is incurable, under control.”

Many of us don’t think twice about ditching our medicines before the dosages run out, although the risks of stopping suddenly are real. Here are the most commonly cited reasons:

“I thought I was fine.”

Amar Shankaran* of Mumbai, who has suffered from bouts of depression, had been on a daily “maintenance dose” of antidepressants for about eight years. This had helped and Shankaran didn’t have to battle depression for a long time. Amar now felt confident and believed he’d never be depressed again, and so—without asking his psychiatrist—he decided to wean himself off the medication. He started taking the antidepressant every other day, sometimes twice a week, and sometimes went without it for days. Within a year the depression returned. “Fortunately, I went to the doctor as soon as I felt it coming back,” says Shankaran. “It was milder this time but a bout of depression, even if it’s mild, it isn’t something you wish for.”

BOTTOM LINE
Dr Kersi Chavda, Shankaran’s psychiatrist and a consultant at Mumbai’s P.D. Hinduja Hospital, says patients who insist on discontinuing their medication must do it only under a doctor’s supervision and keep their family in the loop to watch out for any untoward behaviour. “A better idea is to continue an adequate maintenance dose, no matter how small. It reduces the chances of a relapse to zero,” he states. Amar has since taken his one little maintenance pill every day and has lived a depression-free life for four years.

“I keep forgetting.”

Rathika Kalyani, a 33-year-old Bangalore homemaker, had several other things on her mind instead of her medication for hypothyroidism. With two young children and the early-morning bustle around the house, Rathika was irregular with the medicine for her under-functioning thyroid for over a year. “I was diagnosed with the condition between my two pregnancies and was especially careful about taking my medicines regularly,” she says. But after her second child was born, priorities changed. “My carelessness took its toll—I became overweight, lethargic and was unable to focus on anything for long periods,” Rathika says. “What’s worse, due to poor concentration, I couldn’t care for my younger child the way I did for my older one.”

BOTTOM LINE

“It’s very common for women to become irregular with prescribed medication when they’re no longer pregnant,” says Dr Gayathri Kamath, obstetrician and gynecologist at Fortis Hospital, Bangalore, “but such negligence can have long-term effects.” Doctors like Kamath advise building a daily routine with a focus on your dose of medicines. That way you’re less likely to forget about them. Rathika is regular with her medication once again and having regained her energy, she now works as a preschool teacher.

“I didn’t want to be too dependent.”

Shefali Chaturvedi was always reluctant to take the medication for her migraine. So the 43-year-old New Delhi senior executive took a decision that went against her doctor’s advice. “When the headaches started seven years ago, I put off getting treatment until the condition was debilitating. Once I saw the doctor, I was afraid of getting hooked on to the drugs.

So, after four years of sticking to the prescription, I decided to discontinue my medicines,” she says. Three months after that, she was back in the clinic with headaches of greater severity and frequency.

BOTTOM LINE
Migraine medication works by reducing the frequency, intensity and duration of the attacks. It also helps you abort or cope with the headaches when they occur. “But patients are often ignorant about how the medicines work, so they fear dependence,” says Dr J.D. Mukherji, head of neurology at Max Super Speciality Hospital, New Delhi. “Ensure complete communication with your doctor. To understand why a medicine is prescribed and why you have to take it for a certain period or continuously, meet the doctor when both you and the doctor are not in a hurry and discuss it.” That way, you’ll be at ease and your medication will be able to do its job.

“It wasn’t available.”

Sachin Gaikwad, 31, of Daund, near Pune, had been taking medication thrice a day for epilepsy when he ran out of the medication one day. A chemist told him that the drug was unavailable. “I hadn’t had a severe attack since I’d started treatment six months earlier, so I didn’t worry too much and thought I’d be fine,” he says. He was—for a few days. Then the giddiness and panic started to resurface. Even so, 20 days passed before Gaikwad contacted Dr Rajas Deshpande, his neurophysician at Ruby Hall Clinic, Pune.

BOTTOM LINE

“Patients like Gaikwad need to be very careful. They must have the right amount of drugs in the their bloodstream to keep the problem in control,” says Dr Deshpande. He advises those for whom it is absolutely necessary to follow prescriptions to keep an extra dose of the medicines with them always. In addition, maintain a list of chemists (in your area, along with their phone numbers), who stock the required medication. If you’re still unable to find what you need, contact your doctor immediately. “If Gaikwad had called me from the medical shop, I could have discussed the matter with the chemist and maybe suggested an available alternative for the interim,” says Dr Deshpande, “but he didn’t.”

“I heard about a miracle cure.”

Kolkata homemaker Srabani Banerjee* had been taking prescription medication and insulin injections for diabetes. After about a year of meticulously following the doctor’s orders and stabilizing of her glucose levels, Srabani stopped visiting Dr Nirmalya Roy, her diabetologist at Kolkata’s B.M. Birla Heart Research Centre. But, six months after she stopped going there, she was back at Dr Roy’s clinic just as suddenly. “Srabani had hoped the treatment would be discontinued after her diabetes was in control. But when I explained that that was not possible, she was disappointed,” says Dr Roy. So Srabani, who is in her early 50s, had taken the advice of a relative and started consuming a powder provided by a native healer with every meal. The healer had claimed the powder would cure her and that she’d never have to take doctor’s medicines again. After those six months, during which she was depending only on the “magic” powder, Srabani’s sugar levels became dangerously high again. She also contracted a severe urinary tract infection.

BOTTOM LINE

“Treatment for a condition like diabetes is lifelong,” says Dr Roy. “People struggle to come to terms with the idea that the condition is here to stay and claims by quacks often sway them.” If you hear of a line of treatment different from the one prescribed by a qualified doctor, it’s always safer to speak to the doctor before making a change or even combining it with your prescribed medication. “The two products may react badly, so taking advice even before making any change or addition is important,” adds Dr Roy.

Finally, my sore-eyed colleague. He stopped the antiviral too and started on homeopathic drops. Even after his red, conjunctivitis-affected eyes looked normal again after about three weeks, they burned, itched and watered for months. There were times when he wondered whether his eyes had been permanently damaged. “Anyway, I was lucky I recovered,” he now says. “I should never have stopped the antibiotic or changed medicines on my own. I never studied medicine and I’ve learnt never to play doctor.”

Take the Tried-and-True

All things being equal, it’s prudent to take older drugs whose side effects are known instead of new drugs that have less data. “It has always been unfortunate but unavoidable that some adverse effects may not become apparent until a drug has been in wide use,” says Peter J. Pitts, president of the Center for Medicine in the Public Interest, USA. Sometimes it takes years and millions of users for a pattern to emerge.

When prescribed a new drug, ask your doctor why it is a better choice than something long on the market. Also ask about any known serious side effects.

Speak up. Trust your instincts. If you experience any new physical or mental symptoms, consult your doctor as soon as possible.

Dealing with Side Effects

All medications have risks and benefits. Weigh both sides of the equation with your doctor, and be prepared by asking yourself these questions:

Do I feel normal, or does something feel really out of whack?

Do I feel unusually depressed, anxious, or uncertain?

Do I have blood in my stool or urine?

Am I very drowsy, dizzy, or confused?

Am I troubled by being unable to sleep, eat, or take part in activities that I normally enjoy?

If you answered yes to one or more of these questions, you and your doctor may decide to:

Lower the dose.

Change the way you take the medication (eg: combine it with meals).

Switch to another medication.

Try a drug-free period (sometimes called a drug holiday) to see if side

effects are medication-related.

Discontinue medication completely (perhaps making lifestyle changes or using natural remedies).

Beyond Bureaucracy Challenge: How do Organizations Conquer Bureaucracy?

By M H Ahssan

To sustain high performance, organizations must build the capacity to learn and keep changing over time.

If you’re like most senior executives, you want your organization to be exemplary. But if you’re honest with yourself, you also know that it’s not and that, in fact, you’re not even sure what exemplary means or how you’ll ever get there. Most management writing won’t help: despite the multitude of volumes written on organizational excellence, nothing we’re aware of combines a view on the “steady state” of high, sustainable organizational performance with a dynamic perspective on how companies can transform themselves to achieve it.

We’ve tried to fill that gap with our forthcoming book, Beyond Performance: How Great Organizations Build Ultimate Competitive Advantage (Wiley, June 2011), from which this article is adapted. Our central message is that focusing on organizational health—the ability of your organization to align, execute, and renew itself faster than your competitors can—is just as important as focusing on the traditional drivers of business performance. Organizational health is about adapting to the present and shaping the future faster and better than the competition. Healthy organizations don’t merely learn to adjust themselves to their current context or to challenges that lie just ahead; they create a capacity to learn and keep changing over time. This, we believe, is where ultimate competitive advantage lies.

Getting and staying healthy involves tending to the people-oriented aspects of leading an organization, so it may sound “fluffy” to hard-nosed executives raised on managing by the numbers. But make no mistake: cultivating health is hard work. And it shouldn’t be confused with other people-related management concepts, such as employee satisfaction or employee engagement.

Nor should you study what other companies do and then apply their approach. While you can always learn helpful things from others, we have found that the recipe for excellence in a particular organization is specific to its history, external environment, and aspirations, as well as the passions and capabilities of its people. Creating and sustaining your own recipe—one uniquely suited to these factors—delivers results in a way that your competitors simply can’t copy.

Why health?

The case for health starts with an understanding of how it relates to performance. Performance is what an enterprise delivers to stakeholders in financial and operational terms. It is evaluated through such measures as net operating profit, return on capital employed, total returns to shareholders, net operating costs, and stock turns. Health is the ability of an organization to align, execute, and renew itself faster than the competition to sustain exceptional performance over time. It comprises core organizational skills and capabilities, such as leadership, coordination, or external orientation, that traditional metrics don’t capture.

More than a decade of research and even more of experience have led us to believe strongly that health propels performance—and that, in fact, at least 50 percent of any organization’s long-term success is driven by its health.

Statistical evidence

We have developed a survey to measure organizational health and administered it to over 600,000 employees at more than 500 organizations across the globe. The survey’s immediate purpose has been helping organizations to measure their health and then to improve in areas of weakness.

But the data we’ve collected over the years have also enabled us to study the relationship between organizational health and performance. And there’s a strong positive correlation. Companies in the top quartile of organizational health are 2.2 times more likely than lower-quartile companies to have an above-median EBITDA margin, 2.0 times more likely to have above-median growth in enterprise value to book value, and 1.5 times more likely to have above-median growth in net income to sales.

The results within individual organizations mirror the results from our large sample of companies. At a multinational oil corporation, for example, we analyzed correlations between performance and organizational health across 16 refineries. We found that health accounted for 54 percent of the variation in performance (Exhibit 2).

‘Experimental’ evidence

We’d be the first to admit that correlations should be treated with caution. But the case for health doesn’t rely solely on them. We’ve also tested our hypotheses at real organizations trying to improve the way they work.

At a large financial-services institution, for example, we selected an experimental and a control group that were comparable and representative of the wider organization by criteria such as net profit before taxes, customer economics, and branch staff characteristics. The two groups then implemented a sales stimulation program over an 18-month period—one using fairly traditional performance-focused methods, the other following a more balanced approach emphasizing performance and health.

The results were striking. In business banking, the traditional approach yielded improvements in value of 8 percent, the more balanced approach 19 percent. In retail banking, the traditional approach delivered a 7 percent improvement, compared with 12 percent for one emphasizing performance and health. Similar studies in other industries yielded similar results (Exhibit 3).

Evidence from transformation efforts

Finally, we’ve surveyed thousands of executives who have been through organizational-change programs. Data from one survey, on why change programs fail, showed that what we might see as “the usual suspects”—inadequate resources, poor planning, bad ideas, unforeseen external events—account for less than a third of the failures. More than 70 percent resulted from poor organizational health, manifested in symptoms such as negative employee attitudes and unproductive management behavior. Furthermore, our 2010 survey of executives at companies undergoing transformations revealed that organizations focusing on both performance and health rated themselves as nearly twice as successful as those focusing on health alone and nearly three times as successful as those focusing on performance alone.

Working toward ‘and’

The link between health and performance is good news. Unlike many of the key factors that influence performance—changes in customer behavior, competitors’ moves, government actions—your health is something you can control. It’s a bit like our personal lives. We may not be able to avoid being hit by a car speeding around a bend, but by eating properly and exercising regularly we are far more likely to live a longer, fuller life.

Of course, that doesn’t make the pursuit of performance and health any easier. Most companies know how to keep a close eye on performance, but health often suffers from neglect. We asked more than 2,000 executives to name the areas where they wished they had better information to help them design and lead transformation programs, for example. Only 16 percent chose near-term performance. More than 65 percent chose the company’s health for the longer term.

What’s more, even when companies do understand both performance and health, many pursue them separately. The result can be HR-led “people programs” that bear little relationship to a company’s strategic and operational imperatives, performance-improvement initiatives that cut more muscle than fat, or both.

In our experience, building health and achieving its accompanying performance benefits generally require transformational change. The approach we’ve found most effective for pursuing it consists of five stages, which we refer to as the five frames of performance and health. For each stage, you must answer a basic question that applies to both performance and health and then address a related performance- or health-specific imperative.

While no two change programs are alike, we believe that the five frames contain the key ingredients for an organization-wide transformation that delivers performance and health in almost all circumstances. In what follows, we offer examples from companies that have excelled in one stage or another to highlight what’s required to tackle both aspects of a transformation—with an emphasis on health, since pursuing it as an explicit goal is less familiar to most organizations. Although we firmly believe that each organization must find its own way through the five frames, these examples of companies that have made significant and lasting improvements in both performance and health offer some inspiration, as well as guidance on tactics we’ve seen work well.

Aspire

The importance of setting aspirations that emphasize health as well as performance came through loud and clear in one of our surveys: change programs with well-defined aspirations for both, we found, were 4.4 times more likely to be rated extremely successful than those with clear aspirations for performance alone.

Wells Fargo offers an example of how to pursue both: setting strategic objectives and then defining related health essentials. When current CEO John Stumpf became president, in August 2005, he brought his top team together in a two-day offsite session to debate Wells Fargo’s aspirations for its next era. The performance goal that emerged was to maintain the company’s track record of double-digit compound annual growth in earnings per share and revenue. To that end, the team doubled down on the bank’s long-term cross-sell aspiration of “going for gr-eight” (eight products per customer), with the medium-term goal of adding at least one product on average to its already industry-leading cross-sell rates. The bank’s leaders also set performance targets related to customer loyalty and customer attrition in all key businesses.

But a broader aspiration also emerged, which the team summed up in the phrase “One Wells Fargo.” This idea grew out of the realization that a huge amount of the value the team sought to create lay in what it called “mining the seams” of the organization: working together more effectively across the company’s lines of business to break down “silo thinking” and give customers a better experience that fulfilled more of their financial needs.

Thinking about the bank as One Wells Fargo helped the senior team focus on changes that would be needed to make the organization healthier: management practices related to customer focus, strategic clarity, and collaborating to share ideas and information were all strong within the lines of business but had to be distinctive across them as well. If One Wells Fargo was the strategy, organizational changes would be needed to support and enable it.

Assess

Before you move from goals to actions, it pays to take a hard look in the mirror to understand your company’s readiness to achieve its aspirations. What capabilities matter most to meeting your performance goals, and how strong are they in your company today? What mind-sets about “the way things get done around here” could undermine your quest for health, and what are their root causes? The value of such assessments of a company’s readiness to change can’t be overstated: in our 2010 survey, respondents at companies that diagnosed problematic mind-sets were four times more likely than those that didn’t to rate their transformations as successful.

When Pierre Beaudoin took over the aerospace division at Bombardier, in 2001, for example, he knew that it needed a performance boost to ride out the industry’s post-9/11 downturn. He also wanted the company to become a healthy, self-improving organization. The aspirations he set—Can$500 million in bottom-line savings, along with a continuous improvement in service and products for customers—required lean capabilities that Bombardier lacked at the time, as well as a significant change in mind-sets.

Probing cultural issues wasn’t something that came naturally to a company that prided itself on technical expertise. In Beaudoin’s words, “It was a challenge for me and for my leadership team to explain why we were spending so much time on the ‘soft stuff’ when we could be fixing factories, hardware, airplanes. We had lots of conversations explaining that if we did the soft stuff right, our employees, with our help, would be more able to do what they’re supposed to do, like make our factories efficient and work on engineering problems.”

These conversations and a more formal organizational self-assessment yielded a shortlist of beliefs that limited the value placed on individuals, the role of teamwork, efforts for continuous improvement, and the drive for results. One area where the company urgently needed to change was attitudes toward handling problems. As Beaudoin explains, “Suppose I come to a meeting and hear about four problems, and I slam my fists on the table and say, ‘I don’t want to hear about problems any more; you guys are there to fix them.’ Well, guess what—I’m not going to hear about problems. And that’s how you get yourself in deep trouble.”

Architect

Once a company knows where it wants to go and how ready it is to go there, it must work out the way from here to there. Countless leaders have told us that this is the hardest part of changing their organizations. But it’s also the stage in a company’s journey when efforts to improve performance and health start to fuse: they interlock and reinforce one another as a focused portfolio of performance-improvement priorities becomes a vehicle for shifting mind-sets toward health.

To understand what this symbiotic relationship looks like in practice, consider the turnaround A. G. Lafley famously engineered at Procter & Gamble after taking the helm, in June 2000. Lafley established some explicit priorities for P&G: focusing on 10 out of 100 countries, for example, and on four core businesses. Emphasizing these priorities was critical to P&G’s performance improvement. It also built a platform for one of Lafley’s deeper goals: to make P&G a more consumer-driven and externally focused company—a healthier one, in short.

As Lafley was setting priorities, he decided to draw up a not-to-do list. One item on it was P&G’s “skunk works”: experimental technology projects outside the company’s mainstream businesses. These endeavors—which had an annual budget as high as $200 million—reflected technological goals rather than customer needs and culminated in products and services that had to be “pushed” to the market in the hope they would be taken up. All this worked against Lafley’s customer-focused aspiration. And so the not-to-do list was rigorously enforced: “If we caught people doing stuff that we said we were not going to do, we would pull the budget and the people, and we’d get them refocused on what we said we were going to do.”

Often, shifting mind-sets means changing formal systems, structures, processes, and incentives. At P&G, Lafley made sure that planning processes started with an understanding of consumer trends and reframed the organizational structure to give it a stronger consumer orientation. Finally, role modeling, storytelling, and skill development can also play a vital role in shifting mind-sets. Lafley, for instance, set up an in-house college for managers and dedicated a substantial part of his own time to coaching. Although this soft stuff is often overlooked, it’s vital. Senior executives who told us, in one of our surveys, that they’d implemented initiatives to change their employees’ mind-sets and behavior during a transformation were twice as likely as others to report that it had succeeded.

Act

When it’s time to get moving, pilot programs are almost always the right way to start working on performance. If things go well, successes can be replicated elsewhere; if they go awry, you can confine mistakes to a small area. Early results also help to build your employees’ motivation and appetite for change. One key to successful pilots, we’ve found, is conducting them in two stages: first, a standard proof of concept and, second, a proof of feasibility, which will ensure that you have a replicable means of capturing the value you’ve identified across your organization. Too many companies don’t take the second step and find that they can’t build on their initial success.

But even the most carefully constructed pilots aren’t enough. Lasting, healthy change also requires an organization motivated to go the extra mile over and over again as employees carry out their routine, day-to-day tasks while fundamentally rethinking many of them. The whole process can feel like trying to change the wheels of a bike while you’re riding it. Not surprising, most companies find this difficult: one of our surveys found that only some 30 percent of all executives who had been through a transformation thought their companies had been completely or mostly successful at mobilizing energy in it.

CEO Julio Linares took the reins of Spain’s incumbent telecom operator, Telefónica de España, in January 2000, as earnings and cash flow were sliding. He used three methods to create a powerful engine for change as he transformed the company. The first was to help people “understand how the project they were working on would contribute to that year’s targets and, therefore, to the overall transformation program.” With that goal in mind, Linares and his team emphasized growth, competitiveness, and commitment as critical themes. Developing new distribution models and improving customer segmentation came under the heading of growth; adopting lean work processes and enabling online transactions, of competitiveness; and embedding a new set of company values and reorganizing business units, of commitment.

Second, Linares ensured that the whole company felt ownership of the changes. He and his senior team brought the telco’s top 500 executives together every January, for example, to help design the program for the year to come. Beyond this core group, Linares sought to “give relevant people at different levels of the organization an opportunity to participate” in the redesign of the transformation program “and then to complement that with a strong communication program.” Sometimes, companies need to reach out even further to create a shared sense of ownership. When structuring the transformation of India’s Larsen & Toubro, CEO A. M. Naik explained, “We involved one in four employees, about 7,000 people. I visited 38 locations of the company.” He added, “When the vision was finalized” in a document, “everyone could say, ‘That word was mine,’ you know? Maybe that word was in the minds of a thousand people. But the process created a shared vision everyone could believe in.”

Finally, Linares used progress evaluations, which are always important, as a third tactic for maintaining energy. Linares explained the need for them in this way: “The market is going to change constantly, and because of that you need to make a constant effort to adapt your company. Some parts of the program will end, but new ones will come up.”

Advance

The final stage is to make the transition from the intensive work and constant upheaval of a transformation to a period of continuous improvement. According to one survey, companies that build a capacity for it into their organizations are 2.6 times more likely to consider their transformation programs a success over the long term.

Continuous improvement can be cultivated during a major transformation effort by building an infrastructure, as you go, that includes knowledge sharing, learning methods, and expertise to help the company continue to improve. For these to be embraced after the initial transformation effort is complete, the right leadership skills and mind-sets must be in place. After the formal end of a transformation program at ANZ Bank, for example, the company trained more than 6,000 leaders in areas such as self-awareness, resilience, and the ability to energize oneself and others. The response was tremendous: participants spoke of the program’s “profound impact” and described the experience as “life changing.” ANZ also held other personal-leadership workshops to develop its employees’ ability to improve continuously, cascading the workshops right through the organization in a process that eventually touched more than 26,000 employees.

These efforts helped ANZ usher in an era of nonstop progress, which included grassroots business initiatives, organizational delayering, bureaucracy busting, internal job markets, and greater diversity. Supporting these endeavors were some 180 “champions” who worked, on top of their regular jobs, to foster continuous improvement in the businesses.

ANZ’s strong financial performance, in the years after its transformation, was accompanied by striking evidence of organizational health: it had the highest level of staff engagement of all peer organizations in Australia and New Zealand, and the share of employees who agreed that “we live our values” and “are earning the trust of the community” was 85 percent and 81 percent, respectively.

If you want to change your organization for the better and to make the changes stick, you must focus on its long-term health even as you push for higher performance now. We hope our research has convinced you that this sensible-sounding but often-ignored maxim is true. And we hope you see, from the examples earlier in this article, that practical insights and tried-and-true tools will let you tackle performance and health simultaneously. We fervently believe that business, and even society as a whole, will improve when organizations begin to report—and be judged—on their health just as frequently and rigorously as they are on their performance.

A Possible Remedy for Poor Health Care in India

By M H Ahssan

India wants to be a preferred destination for medical tourism, but its health care offering for its own citizens is lacking. The doctor-to-population ratio for the country is 6:10000, compared to a global ratio of 14:10000. It is estimated that over the next two decades, India will need twice as many doctors, three times as many nurses and four times as many paramedics it has at present.

With 60% of the hospitals and 80% of the doctors belonging to the private sector, and 70% of the health care resources in India concentrated in the top 20 cities, rural India is hit the hardest.
To address this problem, the Medical Council of India (MCI) has proposed a truncated medical course for practitioners in rural areas. Called the Bachelor of Rural Medicine and Surgery (BRMS), it is a three-and-a-half-year course aimed specifically for students from rural India to take care of the basic health care needs of the target population.

The proposal for the BRMS, initiated by the MCI a couple of years ago, has recently received the backing of the country’s Planning Commission. A report released by an expert group within the Commission notes that the course should focus on “high quality of competence in preventive, promotive and rehabilitative services required for the rural population with a focus on primary health care.” It also recommends that by 2020, India should have BRMS colleges in all districts with a population of over 500,000. The report clarifies that this is not a shortened version of a traditional medical degree (MBBS) course, but a unique initiative to address the country’s rural health care issues.

Not everyone is convinced of the efficacy of the BRMS course. In an address on the website of the Indian Medical Association, its president, Vinay Aggarwal, points out that the course is akin to “promoting and legalizing quackery.” He adds: “While modern medicine is experiencing a knowledge explosion, and a five-and-a-half-year MBBS course is insufficient to provide basic information to would-be doctors … how can reducing the duration of training be the remedy to the maladies plaguing rural health? Compromised education, and training in institutions where infrastructure and faculties have been compromised, will compromise the health of villagers …. An army of half-baked doctors for villagers with a three-and-a-half-year curriculum is a gross injustice.”

Rana Mehta, executive director, PricewaterhouseCoopers, India, disagrees. “I see it as a positive step,” he says. “In one way it is a compromise, because you don’t do the [traditional-length] course, but given the huge shortage of doctors in India, this is a very good and innovative move.” The only caution that Mehta adds is that BRMS practitioners “need to keep within the paradigm of the knowledge that they have.”

There have been other innovations in India’s health care sector. At Devi Shetty’s cardiac care hospital, Narayana Hrudayalaya, for instance, patients are treated for heart ailments at a fraction of what it would cost elsewhere across the globe. Shetty attributes this to “process innovation.” And at the Indian arm of GE Healthcare, the goal is to innovate and make affordable and accessible health care products to meet the specific needs of the Indian population.
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It now remains to be seen whether the BRMS ranks among these and other innovations from India — or whether it will prove the skeptics right.

Apple Without Steve Jobs: How the New CEO Can ‘Think Different’

By M H Ahssan

When people think of Apple, in addition to thinking of now-iconic products like the iPhone, iMac and iPad, they think of Steve Jobs, standing on a stage in his ubiquitous black turtleneck and jeans unveiling the latest in a string of innovative products from the company he co-founded in 1976.

On Wednesday, Jobs announced his resignation as CEO, ending a 14-year run that brought the company back from the brink of bankruptcy and reshaped the personal technology industry. Although Jobs, who has been on medical leave since January, will remain as chairman of the board, Apple chief operating officer Tim Cook will take over the day-to-day running of the company — and the daunting task of becoming the new face of Apple.

But Apple’s success is due to more than Jobs alone, says Wharton operations and information management professor Eric Clemons. “Apple leadership has been brilliant,” he notes. “The team, clearly led by Jobs, but clearly more than Jobs alone, has become the best technology style house in the world. We pay a premium for Apple products because of how they look and how they feel foremost, and then how easy they are to use and to integrate into the rest of our technology and into our lives.”

Among Jobs’s biggest strengths were the ability to determine what the customer wanted and the will to force through “bold decisions that ultimately proved to be correct,” Clemons says. “In some ways he was indispensible. But he was never the whole story.”

Cook, who joined Apple in 1998 after stints at Compaq and IBM, also ran Apple during Jobs’s previous medical leaves. As COO, he oversaw the launch of Apple’s online store, fine-tuned its manufacturing process and revamped its customer support arm. Although Cook has appeared at least once in Jobs’s trademark black turtleneck and jeans, Wharton management professor Peter Cappelli says it would be a mistake for him to adopt a leadership style that copies Jobs. “A copy of anyone is going to come off looking bad. It will never be as good as the original, and people will spend their time focusing on the differences,” Cappelli notes. “I think [Cook] should be himself.”

But when it comes to Apple’s business strategy, Cappelli says it would be unwise to depart in any significant way from the path set under Jobs. “I think a ‘steady as she goes’ approach is a good idea, and also about the only option at this point.”

Apple shares fell 7% when news of Jobs’s departure broke Wednesday night, but the drop had narrowed to 2% by this morning. Most analysts expected the company to remain strong in the post-Jobs era, although Deutsche Bank cautioned that “risk is more likely to be centered around Apple’s three-to five-plus year product plans if/when Jobs permanently departs,” the Wall Street Journal reported.

And JMP analysts put a rare “hold” rating on the stock, noting that “it is not immediately evident to us how Apple replaces the irreplaceable and we are maintaining our neutral stance on the stock until it becomes clear — either that innovation and operational efficiencies will continue unabated under new management or that they are breaking down.”

According to Clemons, Cook must emphasize that, although Jobs is no longer at the helm, the design and strategic teams behind Apple’s success will remain intact. He says Cook could also buy back stock if the price drops temporarily. “The fundamentals of Apple as the premier high-tech design house and the premier integrated consumer technology company have not altered.”

Life after Steve Jobs: What to Expect from the Next Generation at Apple

It has been a wrenching six weeks for Apple. First, in a not entirely unexpected move, CEO Steve Jobs announced on August 24 that he would step down for health reasons and pass the torch to chief operating officer Tim Cook, who had temporarily taken the helm during Jobs's past medical leaves.

But Jobs was expected to remain a force behind the scenes at the company he co-founded in 1976 and built into a perennial game changer for the entire technology sector. Then, last Wednesday Apple announced that Jobs had passed away from cancer at the age of 56. Rather than a gradual transition, Cook and the leadership team Jobs leaves behind now face a baptism by fire.

"Steve Jobs wasn't just Apple's CEO," Wharton legal studies and business ethics professor Kevin Werbach says. "He was its animating force for most of the company's 35-year existence, and especially after his return 15 years ago. Today's Apple is, in many large and small ways, a reflection of Steve Jobs's vision. That makes it much easier to continue that culture even without Jobs himself."

The Apple that Jobs leaves behind is in an "enviable position, financially and in terms of its influence in the global technology sector," Werbach notes. But can the company sustain its track record of success without the man who was the company's guiding influence? Should Apple continue to mold its culture in the image of Jobs -- or is it time for a change?

"The challenge for Apple is that the Steve Jobs culture is a high-risk endeavor," Werbach says. "Apple is more controlling than its competitors, which puts a great deal of pressure on it to produce things that are truly superior. Apple has to hit it out of the park with virtually every major product release. It has done that for years, as has Pixar. However, the risk is higher than for companies like Microsoft, Facebook and Google, which have more ability to refine and improve their offerings over time, or to leverage the work of partners."

In a letter to employees after Jobs's death, Cook said the company has lost a "visionary and creative genius," but "his spirit will forever be the foundation of Apple." Yet what may be Jobs's more enduring legacy, at least in the short term, is the management team he built since returning to the company in 1996 after an 11-year ouster.

"Apple has done a good job of demonstrating that the leadership team in place is capable of managing the company just fine. A few years back, Apple and Steve Jobs were largely synonymous," notes Kartik Hosanagar, an operations and information management professor at Wharton. "With the decline in Jobs's health in recent years, other executives have been taking on more responsibility in a public way. All this has largely helped convince the community that the management is in control and knows what it is doing."

At Apple's iPhone 4S press event at its Cupertino, Calif., headquarters last week, Cook started with an introduction and then handed off the presentation to Eddy Cue, senior vice president of Apple's Internet software and services products; Scott Forstall, senior vice president of iOS, which powers the iPad and iPhone; and Phil Schiller, the company's head of marketing. Jonathan Ive, senior vice president of industrial design, is another key executive tasked with developing hit products. Cook is considered to be a supply chain expert and CFO Peter Oppenheimer controls the financials.

"All the executives have been with Apple for quite some time," Wharton management professor David Hsu points out. "Many of those executives came with Jobs from NeXT," the computer company he started after being pushed out of Apple in 1985. Apple bought NeXT in 1996 to acquire the operating system that became Mac OS X.

Little is expected to change at Apple in the short run -- for example, product roadmaps are typically set three to five years in advance. "We believe Tim Cook will carry out a long-term (five-year) roadmap that he and Jobs jointly established, including several iterations of Apple's existing products as well as new categories, like an Apple Television as soon as late 2012," Piper Jaffray analyst Gene Munster wrote in a research note.

In addition, "the industrial design excellence embodied in Apple products is likely to persist. The genius behind Apple's industrial design is really Jonathan Ive. He's alive and well," notes Karl Ulrich, an operations and information management professor at Wharton. "While Steve Jobs was clearly a champion for excellent industrial design, the Apple industrial design team is the best in the industry."

But there is no getting around the fact that, as it moves from a company built around one man's vision to more of a team approach, Apple will have to start doing things differently. And beyond any leadership challenges, the company is also operating in a highly competitive and quickly evolving sector where a number of companies are grappling to take the lead on smartphones, tablets, digital music and cloud storage initiatives. "At this point, Apple has a firm, loyal customer base," says Wharton legal studies and business ethics professor Andrea Matwyshyn. "What happens in two to three years may be different story."

Indeed, the future is not just about what Cook and his team can accomplish. "I suspect the CEO who will have the difficult job at Apple is Tim Cook's successor," Werbach notes.

Teaching Companies to 'Think Different'
To capture Jobs's keen eye for the intersection of art, technology and product design, Apple in recent years began a top-secret internal training program called Apple University. The aim was to establish a system that could pick up the slack when Jobs was no longer with the company. In 2008, Apple hired Joel Podolny, former dean at the Yale School of Management, to design Apple University. Podolny specialized in organizational behavior as well as management. The Los Angeles Times reported that Jobs was actively involved with developing Apple University and imparting his DNA into the program.

The effort highlights how important it is to maintain Jobs's ethos at Apple. But Wharton management professor Jennifer Mueller questions whether a training system can truly capture what made Jobs unique. To Mueller, Jobs's biggest feat was coming up with creative ideas and, more importantly, convincing partners, employees and consumers to buy in. "Apple University is a great idea, but in addition to thinking like Jobs, there's the separate skill in gaining acceptance for creative ideas," says Mueller. "Jobs's skill was to promote himself as charismatic and not crazy."

Wharton management professor Saikat Chaudhuri agrees that it is difficult to capture Jobs's knowledge and intangibles and embed them into Apple's business processes. "The question is whether Jobs's approach was actually captured in a process," says Chaudhuri. "Jobs had a vision and was able to charismatically convey to people what was needed."

For Hsu, Apple University's challenge will be to replicate Jobs's ability to innovate. Case studies only go so far, Hsu notes. "Apple University is an attempt to codify how management worked through challenges. It's quite different for a corporation to try to do that. Ultimately, the question is: Where does the creative spark come from at Apple?"

From Vertical to Horizontal
Under Jobs, Apple was often secretive about its products and processes, and most information flowed directly through the CEO. Now that the focus has turned more to a group of top leadership, "there will have to be the ability for new ideas to flow horizontally," says Matwyshyn. "A hierarchical organization worked under Jobs, but won't with a team approach."

Matwyshyn notes that Microsoft's leadership handoff from Bill Gates to Steve Ballmer suffered from a change in the way communication was handled at the company. Gates "was hands on with engineering and served as an information clearinghouse," says Matwyshyn. It was he who often connected different product teams and put leaders of certain areas in touch with each other.

But this type of approach is not always the healthiest for companies over the long term, according to Wharton marketing professor Peter Fader. "Apple was so fortunate that it was able to have all their eggs in one basket [with Jobs] and survive," says Fader. "No company wants a situation like that. It's important to let others get the limelight. Cook will yield the spotlight because it's the right thing to do as a leader." Cook seems to understand this: In addition to the way the entire team was showcased during the iPhone 4S announcement, Apple's announcement that it received one million preorders in a day for the 4S included a quote from Schiller rather than the CEO.

In many respects, Apple was able to "take a remarkable set of idiosyncrasies, technology and Jobs's personality" and use them to succeed, Fader adds. "This formula works at this point in history, but it's not clear whether it will work 10 years from now."

Mueller's research illustrates the challenges Apple may face as it transitions from moving product decisions primarily through Jobs to a team of executives and managers. In a study that looked at 212 knowledge workers in 25 teams ranging from three to 19 members in size, she found that larger groups at the top often "experience more coordination loss or difficulty and inefficiency." "It is so hard to get ideas through the pipeline at large companies," Mueller says. "Creativity is viewed as risky and the corporate culture is designed to squash creative ideas. Will the average person rising through the ranks be rewarded for being creative?"

Regression to the Mean
But Fader predicts that Apple's biggest challenge will be a regression to the mean, the statistical axiom that says high-flyers and breakneck growth rates eventually slow to the industry average. "There's one direction things can go at Apple, and that's down."

According to Fader, some kinks are starting to show in Apple's armor. Although the iPhone 4S scored record-breaking preorders, reaction to the device itself was mixed, with many left disappointed that the company did not introduce a 4G-enabled iPhone 5. Meanwhile, music streaming services such as Spotify could overtake iTunes; Android-powered mobile devices continue to gain ground on the iPhone, and new entrants to the tablet market, such as Amazon, could provide significant competition in that area. "Nothing I've said so far indicates that Apple is stumbling, but there are limits to boundless growth," Fader says. "There are so many things going on in the market that are independent of who is running Apple."

Google and Amazon are fierce rivals to Apple, and it is unclear whether the company Jobs left behind can maintain profit margins in the years ahead. In addition, Jobs landed sweetheart deals from wireless carriers such as AT&T and Sprint and also schmoozed media executives to procure rights to music, TV shows and movies for Apple's various platforms. The new executive team may face more challenges dictating favorable terms for Apple. "Steve Jobs was a persuasive personality, and his larger-than-life image was instrumental in getting partners to agree to new business models," notes Ulrich. "My main concern would be whether the current leadership can close similar deals going forward."

Wharton management professor Lawrence Hrebiniak says the biggest wild card facing Apple is how quickly a regression to the mean might occur. "It's hard to stay on top in a competitive environment. Ford, IBM and Microsoft all had good teams and fell from the top. A competitive environment levels the playing field." But Werbach notes that slowed growth for Apple doesn't necessarily lead to shaky ground financially. "Look at Microsoft: In many ways, it has floundered for a decade since Bill Gates stepped down, but it's still making money hand over fist."

Market shifts aside, Ulrich suggests that it would be a mistake for Apple to attempt to maintain the company as it was under Jobs. "It would be foolish to bring in Tim Cook in a black mock turtleneck sitting on a stool to introduce Apple's next big thing. That approach worked only for Steve Jobs. However, alternative approaches that rely less on a single personality and that focus more on the product and its benefits may be equally effective."

If Apple has institutionalized the Jobs approach with processes, technology and people, the company should continue to thrive, according to Hrebiniak. "Was it Jobs, or was he creating a culture where brilliance is transferable? That's the big question. Are the culture, structure, incentives and processes there so that the company can continue?"

Boss, can I be your ‘yes-man’?

Nearly every work of fiction involving a workplace depicts a boss with his or her favourite ‘yes-man', the one who seconds the boss' opinion with unquestioning faith. But does this stereotype hold true?

While no one can dispute the existence of "yes-men", industry experts are unanimous in their opinion that these individuals have no place in a professional organisation. "It is not true that every boss needs a yes-man in his/her life. The boss should be able to inspire enough confidence among team-members for them to be able to speak their mind, even if their thoughts are not in line with what the boss is saying. Further, they should be given the opportunity to reason with the boss and share their point of view," says Sudhanshu Pandit, director HR Symantec. Jay Singh, co-founder and executive director, JSM Corporations Pvt Ltd agrees, "In yesteryear's, the idea of having a yes-man used to work, whereas today, almost all employees have the ability to voice their own opinions."

The primary concern seems to be that the presence of a yes-man might inhibit other employees from expressing opposing viewpoints. However, what when an employee's thoughts are genuinely in consonance with his or her superior's way of working? Could an employee with a cooperative and an agreeable attitude be mistaken for a yes-man? "Yes, I do agree that such an employee can at times be mistaken for a yes-man by the other team members in the organisation. This is basically human nature to view things from one's own perspective and draw personal conclusions," opines Narinder Anand, MD, Valueline.

While constructive conflict can be highly productive, every team needs members who can calm the situation and see everyone's viewpoint. "Any employee who has an attitude, which is both cooperative and agreeable, cannot be mistaken for a yes-man. Employees are free to be cooperative and present their opinions on a particular subject. It's not necessary if they will agree to each and every thing as they are working towards the best interest of their company. I personally admire people who have a different outlook and think differently with valid reasons justifying their thinking," says Singh.

Debasis Chatterji, CEO, Netxcell Limited presents a different perspective altogether. Chatterji believes that every boss has his/her "right hand", who is often dismissed as a yes-man by one's co-workers. He elaborates, "With growing work pressure and cut-throat competition, it is becoming continuously difficult for the boss to look into minute details of each function. Therefore, he/she has no other choice but to depend on a few members to avoid going through each process or document in detail, thus getting more time and resources to concentrate on the core activities. On the whole, every leader worth its salt has a core few persons with absolute faith to make their work-life more effective. However, for other team members, such people who have the boss' confidence are perceived as yes-men."

Sometimes bosses don't realise that they have a yes-man under them and simply revel in the confidence that this employee seems to consistently place on them. "A boss who is very pleased with his/her yes-man will create an environment that does not breed competition/change. Team members shall grow to realise that they need to ‘fall in line' with the boss so as to earn recognition," affirms TN Shekar, CEO, LIVIA Legal.

In a nutshell, irksome but constructive criticism is any day more beneficial than meaningless agreement, right?
 

The power of creative thinking

How many of us quit our high-paying jobs for an opportunity that is more exciting, more creative and stimulating?

A common complaint that many individuals hold against corporate workplaces is that they are ‘routine' and ‘mundane'. How many of us quit our high-paying jobs for an opportunity that is more exciting, more creative and stimulating? For those of you who can't take that bold step towards quitting, the good news is that creative thinking and corporate workspaces are not mutually exclusive at all. In fact, if you are creative, chances are that not only will you be satisfied with your work, but also enjoy a competitive edge.

"Over a period of time, all tasks tend to get monotonous for individuals. An effective way to break the monotony and increase productivity is to encourage creative thinking at the workplace. This always engages the individuals and develops the ability to think beyond the defined boundaries of the process," says Vipul Singh, VP and HR head, ADP India. To foster an environment that encourages independent thinking and innovation, some companies are now launching a platform called iBank – an idea bank, where each associate can share their thoughts about any aspect of the organisation. These ideas are then implemented and the best ones are rewarded.

Being creative does not necessarily involve going out of your way to do things differently. Even the simplest daily tasks can be made creative, as it is more of a mindset shift and the way you approach things uniquely. Ultimately, it leads to both personal and professional growth for an individual. Ramesh Loganathan, VP, products and center head, Progress Software Hyderabad says, "The more creative an individual is, the more valuable he/she is. This will result in career development and growth. Creative talent enables an individual to work smartly therefore, resulting in the best possible outcome."

While many believe that creative talent is inborn, there are several ways of nurturing and developing it amongst oneself. The reason why some people are more creative than the others is that they make an effort to consciously polish this art. Environmental factors also play a critical role in this. "At a basic level, creativity is a fundamental ability one is born with. Experience and training, however, can hone the skill. Also, the right environment and an inspiring management can induce and amplify creative inputs," feels Loganathan.

"It is the outlook and approach encouraged within organisations and social circles that determine the ability of individuals to be creative. Creativity does not always mean going beyond the expectation and radically changing the situation; it is the ability to look at the situation as a whole, use your instincts to act upon the situation and work out solutions. A right mix of analytical thinking, structured approach and looking beyond just the problem at hand can make people think creatively," agrees Singh. "An individual who has the ability to envisage the complete situation, but does not have an analytical and logical approach to the problem, will not be able to succeed in converting the vision into a reality. Individuals who can have the right mix of both worlds will be the ones to have the maximum stretch with this kind of approach," he adds.

What are some of the ways to encourage creativity? "To nurture creative talent, two aspects are very important. You need to have the ability and independence to look beyond just the problem at hand. Every individuals creative outlook should have a positive impact on the desired results. The best way to cultivate creativity is to imagine a world with endless possibilities and not boundaries. In today's world, creative talent is not a rare find. Creativity is created within organisations with the right vision and environments that encourage individuality and abstract thinking," says Singh.

So, if you think you are lacking in terms of the creative quotient, there is no reason to worry. With an open mind and a firm belief, the power of creative thinking will not remain far from your reach.

Work-life balance - only for women?

Every employee, be it a male or a female, deserves to have sufficient time to spend with his/her family and participate in extra-curricular activities that help him/her de-stress.
The moment we hear the term ‘work-life balance,' instantly the image of a hard-working woman juggling her office along with her household flashes through our mind.

Though this scene indeed deserves a lot of thought and action, is this the only picture that needs to be taken care of? Women have stepped onto this see-saw quite recently as compared to men. Since generations, we have been seeing men toiling their day off at work, coming late at night and having little to no life outside the imprisoning walls of their respective offices. Then why do we unwittingly end up being chauvinistic about the issue?

It is indeed time that we give up the orthodox notions of work being the only priority of men and reward them with a little space to breathe. Every employee, be it a male or a female, deserves to have sufficient time to spend with his/her family and participate in extra-curricular activities that help him/her de-stress.

Rosita Rabindra, Executive Vice-President and Head HR, NIIT Technologies elaborates how the company ensures the comfort of all of their employees, "We have standard policies for work-life balance and have few additional ones for women like Little NIITian Care Leave to help new mothers slowly transition back to work. We also offer paternity leave in our efforts to ensure that all our policies are aligned to the needs of both sexes."

Furthermore, it is highly essential that facilities be provided on an everyday basis to help employees relax and take a break from their hectic schedule. Manoj Matai, Vice President – Solution & Transition at Jindal Intellicom tells us the recipe to create such an atmosphere, "BPO is a high stress environment, more so the international services side due to the time difference. To reduce stress levels, we have the following unique initiatives:

• Smaller cabs to reduce travel time.
• Gym in the office with high end equipment and full time coach.
• Wellness programs including eye check-up, yoga camps etc.
• Team outings for adventure sports etc. rather than "drink-dance-dine" parties.
• Tasty & nutritious food, cooked in our own cafeteria, under our supervision with the key ingredients supplied by us, rather than food cooked in distant "centralised" kitchens.
• Ergonomic seating, comfortable headsets and noise reduction systems.
• Powerful air-conditioning – cooling and heating.
• I-Care – independent grievance & counselling desk.
• Last but not the least – frequent creative, cultural and sports events, participated at individual and team levels."

There are many companies today which encourage working from home by evaluating the performance of an employee by the results rather than the time spent inside the office. Rahul Kulkarni, Head - HR, Kale Consultants, explains, "We believe that it is not about the ‘x' number of hours you spend inside the office but the work you deliver at the end of the day. We give our employees the freedom to work out of any premises and deliver the performance that is expected out of them. We believe in giving them the option of choosing how and where they want to work rather than creating a structure about it. The performance evaluation programme that we have is such that their working from home doesn't hinder their performance criteria." If such opportunities are provided by a greater number of companies in the market, it would certainly be much easier for employees to handle their work, family and hobbies simultaneously.

It is time for ‘work-life balance' to rise out of its conceptual stage and become a reality in all industries, both for male as well as female employees on a uniform level. But such a phenomenon is only possible if every company rises to the occasion of understanding the needs of all its workers and coining effective and efficient policies for their immediate benefit. This will lead to more satisfied employees and in turn better productivity.