Importing Efficiency: Can Lessons from Mumbai's Dabbawalas Help Its Taxi Drivers?

Mumbai has 150,000 licensed taxi drivers. It has 5,000 dabbawalas, organized porters who carry cooked lunches to office workers. The former, along with about 450,000 auto-rickshaw (three-wheeler taxi) drivers, are constantly in the news for reports of bad behavior, overcharging and even violence. The dabbawalas, on the other hand, are icons of efficiency. They have even made it to the Harvard Business Review as a case study.

Taxis are vital to the city, as public buses cannot cope with rider demand. Mumbai’s local trains transport more than 6 million people each day, according to figures provided by the Maharashtra State Road Development Corporation (MSRDC). At the station of embarkation from the local train, many commuters take a share-a-cab (four to a taxi) to reach their final destination. Anthony Quadros, president of the Mumbai Taximen’s Union, estimates that there are 1.2 million regular taxi users in Mumbai. In this city, nothing is certain but death and taxis.

The dabbawalas don’t have an equivalent in other cities. The 100-year-old organization takes cooked food from people’s homes and supply centers (which could be a housewife-turned-home entrepreneur) and delivers the meals to offices. In this realm, a mistake carries stiff consequences, particularly because religion dictates which foods many people can or can't eat. But the dabbawalas are very close to a no-mistake regime and they have built a great deal of trust.

“The dabbawalas even carry forgotten spectacles and mobile phones,” says Pawan Agrawal, CEO of the Mumbai Dabbawala Education Centre, an offshoot of the Dabbawala Association. “Sometimes, customers even send home their salary with the empty tiffin box. That’s customer service.” Agrawal, who is a spokesperson for the dabbawalas and has done a study on the group's logistics and supply chain management efforts, says that the number of customers in Mumbai has crossed 200,000.

On a superficial level, the two cohorts seem to have a lot in common. Both come from marginalized and oppressed socio-economic groups. Their average education is up to the eighth grade. They belong to a low-skill, working class category and service the city’s middle class. Why, then, are the two groups' reputations so radically distinct?

“The difference stems from the difference in their cultural backgrounds,” says Ramesh Kamble, a professor of sociology at Mumbai University. In India, there are still some professions that are dominated by certain communities. In many Indian cities -- Delhi and Kolkata, for instance -- taxis are run by owner-operators and there traditionally was a preponderance of turbaned Sikhs from Punjab. Today, particularly in Mumbai where the people tend to be a shade more entrepreneurial and adventurous, many of those drivers have moved away, some to the U.S. and Canada.

In Mumbai, most of the taxi drivers are now migrants from the north Indian states of Bihar and Uttar Pradesh (UP). This springs into public consciousness every time the parochial political parties in the state start a “Maharashtra for Maharashtrians” campaign. The first target of the agitating mobs is often the taxi driver. The dabbawallas, on the other hand, belong. According to Agrawal, all but six of the 5,000 dabbawalas come from a particular community of Maharashtrians.

“North India is extremely feudal, with a hierarchical and patriarchal culture. Reclaiming that culture becomes necessary to find space in that group at the place of migration,” says Kamble. “However, in Maharashtra, since the 1920s we have had various kinds of movements, such as the textile workers’ movement, the Dalit [low caste] movement and the feminist movement. The dabbawalas are also deeply influenced by the Bhakti [devotion] movement. Their efficiency is not entirely a management marvel; it is rooted in their cultural values. The same work ethic exists among porters at Mumbai’s railway stations because these working classes have similar cultural contexts.”

But not all seem to agree with the cultural hypothesis. Stefan H. Thomke, a professor of business administration at Harvard Business School and author of a case study titled, "The Dabbawala System: On Time Delivery, Every Time," believes that while the fact that new members are recruited from 30 villages in and around Pune contributes to the organization’s performance, there are many other critical factors that reinforce each other and must be considered. “Most importantly, the dabbawala’s performance can only be understood if we study the entire system -- their culture, management, organization and processes -- and how these factors interact with each other,” Thomke notes. “You cannot copy one single factor ... and hope to replicate performance without regard to others.”

The dabbawalas themselves say that the charge of being a non-inclusive organization is misplaced. Most people believe that you need to belong to the Warkari Sampraday (loosely translated as the Pilgrim Group) to be a dabbawala. Not true, according to Agrawal. The only recruitment criterion is a “guarantee” -- essentially, a verbal assurance of the candidate’s character -- by an existing member. “Most people tend to refer their friends or family members who belong to the same community. It has just worked out like that.”

Advantages of Community
But Agrawal says having employees from the same community has several benefits. “Our values, inclinations and psychology are similar. So there is better understanding and teamwork," he notes. "It doesn’t require talent; it’s just common sense. We wouldn’t be Six-Sigma certified without that coordination. In fact, since we began with one customer and one dabba [lunchbox] in 1890, this has become almost like a family business.”

Quadros of the taxi drivers' union says the one-community culture makes it easier for leaders to manage and retain their employees. “We don’t have that kind of control over our taxi drivers. It’s very difficult, especially with the newer generation.... They drive taxis for about five to 10 years, earn what they can and then do something else. They have no interest in the taxi trade or helping to improve it. The dabbawalas are not migrants; that helps.”

But Varsha Ayyar, an assistant professor in the School of Management and Labor Studies at the Tata Institute of Social Sciences (TISS), notes that even migrant groups have a sense of community. There is also a tendency to join the same profession when they come into a city. Working with others from the same village gives migrants a sense of security when they first arrive. They help to get them a job; a construction worker would be most cognizant of vacancies in his field, for example. And they act as informal mentors, particularly when the newcomer is a relative. In Mumbai, there is a large area known as Sonar Bangla in which illegal Bangladeshis have settled. They number several hundred thousand and tend to stick together.

Migration doesn’t explain everything, continues Ayyar. “The difference is that dabbawalas have more of a sense of autonomy and accountability. The system itself demands that,” she says. “Taxi drivers [in Mumbai] are often not owners of the taxis; there is no sense of ownership and they have to make a minimum amount of money each day, even if it means tampering with the meter.” According to Quadros, taxi drivers are vulnerable. If a driver parks illegally, or merely in the wrong spot, to drop off or pick up a passenger, he often has to bribe the police if caught. Regular extortion for real or imagined transgressions means that drivers must earn more than what is registered on the meter. Fights with passengers, who often know what the exact fare should be, are inevitable. And this adds to the atmosphere of acrimony.

Sense of Social Coherence
But Bino Paul GD, an associate professor at the TISS School of Management and Labor Studies, attributes part of the culture of the dabbawalas to their tremendous sense of social coherence with the city -- they live with their families, eat home-cooked meals and lead respectable lives. “Those factors are more important than community. Taxi drivers have none of these advantages. That seriously affects their morale,” says Paul. Taxi drivers often live in slums with 10 or 15 people to a room. Working conditions are tough -- as mentioned earlier, among the toughest in the world. They don’t have parking space or restrooms. “A lot of them belong to religious minorities,” notes Paul. “They lead anonymous, invisible lives compared to the dabbawalas.”

Then why become a taxi driver at all? That’s a question that could be asked in any large city. “Reservation wage,” says Paul, using a theory from labor economics. “That is the market wage below which people won’t enter the labor force. The reservation wage of Maharashtrians is much higher than that of taxi drivers. Also, there are push and pull factors that facilitate migration. Poverty is a major push factor.”

It’s a tough life. Taxi drivers work 12 to 16 hours a day, seven days a week. They make around US$60 to US$100 a month. Dabbawalas work nine hours a day, six days a week and make US$160 to $US180 a month. They supplement that income by US$80 to US$100 per month doing other jobs, such as delivering newspapers or milk. Some are also part-time taxi drivers. “For [dabbawalas], work is worship,” Agrawal says, citing the group’s credo, “We believe that by serving food, we are serving God. We don’t work for money.”

For the taxi driver, money is a key frustration. “[If a driver doesn’t get enough fares], he gets angry,” Quadros notes, adding that the formula for calculating taxi fares has not been revised by the government since 1996.The taxi drivers’ job, by its very nature, means moving from place to place. Toward the end of a shift, the driver has to maneuver to get back where he started from. In Mumbai, taxis are on the roads 24 hours a day, with one driver replacing the other when his duty is over. The dabbawala on the other hand has a fixed route; his schedule is as regular as a newspaper carrier's. He can tell you where he will be at any given time. The regularity makes for discipline, experts say.

But what about the sheer numbers of taxi drivers as compared with the dabbawalas? Does this have anything to do with their group behavior? Paul of TISS does not think so. “That there are so many more taxi drivers than dabbawalas is not relevant to how well they are able to enforce discipline. When it comes to property rights in terms of ownership or control over vehicles, power lies in a few hands. There are a few [people] that regulate the whole activity, a collective of some interest.”

According to Paul, whether it is taxi drivers or dabbawalas, power structures exist within both organizations. The only difference, he points out, is that dabbawalas have a more formal power structure that is known to everybody. In the case of taxi drivers, there are multi-stakeholder informal power structures.

Is there anything that the taxi drivers can learn from the dabbawalas? Harvard's Thomke views the groups' divergent behavior as a nature vs. nurture battle. “I believe that nature is one input, among many inputs, but it is the nurture -- or the system -- that explains excellent service performance." While he is unfamiliar with the Mumbai taxi trade, Thomke suggests a thought experiment: if the dabbawalas were to run the taxi system, what would they change?

Agrawal says that the taxi drivers' basic organizational structure should be reconsidered. The dabbawalas have several hundred group leaders that are the core of the organization. Each heads groups of 10 to 25 members and is responsible for all their activities. “How can one leader control and be responsible for thousands of drivers?” asks Agrawal. “They should make groups of 20 to 30 drivers reporting to a leader who can properly manage them and inculcate values of honesty and efficiency.”

But Quadros doesn’t think that approach will work. “It is difficult to imbibe the best practices of the dabbawalas,” he says. “Even if I hold a meeting, very few people will show up.”

Diabetes Unravelled

By Aarti Narang

This isn’t someone else’s problem: India has 41 million diabetics. It could rise to 70 million by 2025.

If you have diabetes, the problem is basically this: you have too much glucose in your blood. Glucose is our main source of energy, derived from eating carbohydrates, and is absorbed into our cells with the help of the hormone insulin. If our body has a problem with insulin, the glucose isn’t absorbed.

There’s a range of reasons for this. In some people, their pancreas fails to produce insulin. That’s Type 1. A small number of people become diabetic when their pancreas is destroyed, for example in an accident or during surgery. But for most people with diabetes, the body has problems processing the insulin the pancreas does produce: Type 2.

Actually, within the term “diabetes,” doctors are discovering dozens and dozens of conditions. “The lines are getting fuzzy,” says Dr Sreemukesh Dutta of the Hyderabad-based Research Society for the Study of Diabetes in India, “Earlier, only Type 1 diabetes was insulin-dependent but in the past decade Type 2 diabetes has become insulin-dependent too.”

Adds Dr Greg Fulcher, an Australian expert, “As we learn more, we can identify the conditions more accurately; for example if they’re caused by different genetic abnormalities.

We even talk about a Type 11⁄2, which has elements of Type 1 and Type 2. One day they may become categorized by the underlying abnormalities rather than just being bundled under one issue.”

But for now the big headache for health authorities is Type 2.

That’s where a complicated metabolic process means not enough insulin is produced, or the insulin that is produced doesn’t work effectively.

Type 2 comprises 70 to 80% of total diabetes cases in India, and its incidence is increasing rapidly—so much so that India is often described as the “Diabetes Capital of the World.”

Linked to obesity, the most worrying trend is that it’s being diagnosed in younger and younger Indians. Previously, the onset of diabetes was generally among those above 35. Since the past decade, Type 1 is getting to be increasingly seen among children, while youngsters even in their 20s are developing Type 2. That’s a major problem, since the longer you live with diabetes, the more likely you are to develop complications.

Living with Type 2

When 43-year-old Mumbai businessman Mark Lewis was detected with diabetes in June last year, it came as no surprise. He had already lost his father to complications from diabetes, and at 103 kilos, he too was a potential target for the killer disease. “It was only when I mentioned to my sister that I was forever thirsty and she suggested I get myself tested that we suspected diabetes,” says Lewis.

People most at risk are those that have the classic “apple” physique.

Carrying more fat around the abdominal organs makes insulin less efficient at controlling glucose levels. Routine blood tests in GPs’ clinics pick up most cases, as more often than not the patients have no idea they have diabetes.

When the doctor charted out a plan to control his diabetes, Lewis was determined to follow it diligently.

He was immediately put on medication and followed a 1400-calories-a-day diet set for him. When asked to exercise, Lewis alternated between walking, lifting weights and yoga. By May this year, Lewis had lost 20 kilos. As his blood sugar levels fell, he was weaned off medication. Today, Lewis is keeping his glucose levels in check through the diet and exercise regimen.

People with Type 2 diabetes don’t necessarily need to follow a special diet, but if they are overweight—which over 70% of people with Type 2 are—then it’s important they lose weight.

“Weight loss helps in controlling diabetes and preventing its onset,” says Dr B.M. Makkar, senior diabetologist and obesity specialist at the New Delhi-based Diabetes and Obesity Centre. According to Dr Makkar, a mere 7% weight loss can reduce the risk of diabetes by 58%. In fact you don’t even have to achieve your ideal body weight for it to make a discernible difference.

Most people may think it’s hard to follow a weight-loss diet and exercise regime. But people with diabetes ignore the risks at their peril: all diabetes is serious, and can lead to devastating complications that are usually irreversible and often fatal. Too much sugar in your blood damages the vascular system and organs. That means people with diabetes are much more prone to cardiovascular disease, and are three times more likely than most people to have high cholesterol, high blood pressure or obesity. Many people with diabetes end up dying as a result of a heart attack or stroke.

Blood glucose can also damage the small blood vessels, which causes problems in the eyes (a quarter of patients develop retinopathy, which can lead to blindness), kidneys, feet and nerves. That means that if the diabetes isn’t well controlled, people are looking at kidney failure or lower limb damage requiring amputation.

Exercising and losing weight can reduce the risk of all of these complications, but what many people don’t realize is that their diabetes is a progressive disease. “Only about 10% of patients are able to maintain normal glucose levels with lifestyle modifications, and that too only up to one or two years,” says Dr Makkar. “Most patients will eventually require lifelong medication, not only to control their diabetes but to prevent complications as well.”    

Type 1 Explained

The threat of serious complications weighs heavily on the mind of anyone with diabetes. But it’s particularly tragic when the diabetic is a child.

Childhood is usually when Type 1 diabetes is diagnosed. In Type 1, the body’s own immune system attacks the beta cells in the pancreas that produce insulin. It’s responsible for a majority of diabetes cases.

Type 1 diabetes cannot be prevented. Patients usually have a genetic predisposition but their disease is triggered by something in the environment, such as a virus. Traditionally called “juvenile onset diabetes,” Type 1 can strike at any age. What doctors don’t understand is why it’s increasing. Research is pointing the finger at milk or certain fats inducing diabetes in people with a genetic predisposition, but at the moment these are just theories.

Usually the descent into diabetes is swift and shocking. That’s what happened to schoolgirl Kyra Shroff, diagnosed four years ago at age 12.

Kyra appeared gaunt and would wake up several times in the night to go to the bathroom. Clinical tests revealed her blood sugar count to be 695 mg/dl (the normal fasting blood glucose level is about 100 mg/dl and post lunch blood glucose level is 140).

A controlled diet, constant monitoring of blood glucose levels and insulin injections every few hours brought Kyra’s condition under control. In fact she’s in top form: Kyra recently won the national junior tennis title, and two silvers at last month’s Commonwealth Youth Games in Pune. Unlike Type 2 diabetes, Type 1 is all about controlling the blood—by adjusting the insulin depending on how much carbohydrate is consumed.

People with this disease used to monitor their carbohydrate intake carefully around regular insulin shots. These days, patients are more likely to follow the DAFNE (Dose Adjustment for Normal Eating) plan—they eat anything, as long as it’s healthy, and adjust their insulin intake accordingly.

Though it requires great diligence, Dr Vishal Chopra, diabetes specialist at Dr L.H. Hiranandani Hospital, Mumbai, maintains “DAFNE can be practised if the patient goes to a specialist at an early stage, when the diabetes is easier to control. Unfortunately, most people first go to a GP who may refer them to a specialist only when complications develop.”

The big problem with Type 1 is it’s impossible to accurately supply insulin all the time. If the amounts are wrong, it can be life-threatening: too much insulin will cut sugar levels leading to hypoglycaemia; too little insulin to hyperglycaemia, while a build-up of organic compounds known as ketones in the blood can lead to a ketoacidotic coma.

“We understand the patient’s insulin requirement after two meetings. We determine the requirement after taking pre- and post-meal readings, and monitoring exercise levels, duration and intensity,” says Dr Chopra. “We give them a scale to follow and then it’s not hard to lead a normal life.”

And that’s just what Kyra Shroff is doing. She injects herself with insulin four times a day, after each meal, and keeps a tab on her blood count thrice. Though she cannot take sugar-rich energy boosters as other tennis players do, Kyra continues to train and travel all over for tournaments and manages her school assignments as well. “I’ve learnt that diabetes isn’t an illness,” she says. “It’s just a different way of life that you work around, and it’s no excuse to stop doing other things.”

Adds Firdaus Shroff, her proud father: “Kyra has helped us change our lifestyle too—we now eat healthy and avoid being sedentary.”

Diabetes in Pregnancy
There’s one more cause of diabetes: pregnancy. It’s called gestational diabetes, and the rate is increasing fast—up eight-fold in the last two decades.

The increase might be because women are having babies when they’re older, or because obesity, a risk factor for diabetes, is increasing. The extra stress of pregnancy on the body can cause high glucose levels, but often pregnancy highlights a woman’s predisposition for diabetes: up to 50% of women develop Type 2 within five years of having the baby, not because of the gestational diabetes, but because they were on course to get the disease anyway.

Women with a predisposition to diabetes are at particular risk while they’re pregnant because their energy needs increase, plus hormones pro-duced by the placenta can block the action of the mother’s insulin, causing insulin resistance. These factors mean insulin needs in pregnancy are two or three times greater than normal from about 24 weeks. Up to 16% of women develop gestational diabetes and it’s usually picked up with a routine glucose tolerance test between 24 and 28 weeks of pregnancy.

Alafiya Firoz, 29, a Chennai housewife, is 11 weeks pregnant and has been diagnosed with gestational diabetes. She isn’t surprised—she was diabetic during her previous pregnancy four years ago too. “The diabetes was then diagnosed in the 36th week of my pregnancy. Only one of my grandmothers was diabetic, so I wasn’t really expecting it,” Alafiya says. Immediately, Alafiya started taking a dose of insulin and walking for 30 minutes everyday. She cut sugars from her diet completely and brought her glucose levels under control within a month.

It wasn’t easy, but she had a big incentive: she learnt that babies of women with gestational diabetes could have problems, too. The mother’s glucose crosses the placenta to the baby’s bloodstream, prompting its pancreas to produce more insulin. That can result in larger babies, putting them at risk during delivery. They are also more prone to developing Type 2 later in life.

Women with gestational diabetes have to juggle their insulin resistance with eating a healthy diet for the baby. They are allowed to eat carbohydrates, but are advised to space out their intake: “If the patient is used to eating, say, two chapattis every morning, then we ask them to have one at 9am and the other at 11. This helps keep the sugar levels down,” says Dr V. Balaji, senior consultant diabetologist at Chennai’s Apollo Hospital.

It was a good-news story for Alafiya. Soon after she delivered her first baby, her blood sugar levels were found to be in the normal range: she was no longer diabetic. Doctors warned her that the diabetes could return if she became pregnant again. It has, but Alafiya isn’t too worried. “I’ve kept my weight in check and am restricting my diet,” she says. “I am determined to get rid of the diabetes this time too.”

In fact, many of the health messages that become so important for people with diabetes have relevance for us all. Regular physical activity, a healthy eating plan and keeping an optimum weight are the keys to living healthily with diabetes—and to preventing it in the first place.

THE DIABETES EPIDEMIC
• It’s the fastest-growing disease in the world, with 230 million people already affected.
• Diabetes is the world’s leading cause of heart disease, stroke, blindness, kidney disease and lower limb amputation.
• The incidence of diabetes is five times higher among Asians than it is in white populations.
• By 2025, every fifth diabetic in the world would be an Indian.

CAN DIABETES BE CURED?
A CONCERTED EFFORT IS UNDER WAY TO FIND A CURE FOR TYPE 1 DIABETES. “It’s looking exceedingly promising,” says Australian expert Dr Gary Deed, who predicts it may happen in 10-15 years.

Meanwhile the emphasis is on halting the disease in newly diagnosed cases. Doctors are trying to modulate the immune system so it doesn’t progress to the ultimate destruction of the pancreas.

The other tack is to try to recreate the body’s ability to manufacture insulin, for example by transplanting the pancreas or insulin-producing cells. Stem cell research is also offering hope that these cells may be created in the lab.

As for Type 2, public health messages promoting weight loss and exercise seem to be the best way of stopping the disease in its tracks. International studies have shown that weight loss of just 5-7% and exercising for 30 minutes five times a week lowers the risk of developing diabetes by a massive 60%.

“It may take ten years before Type 2 diabetes stops increasing every year in populations. Then we will see numbers begin to decrease,” predicts Professor Jaakko Tuomilehto, an international authority on diabetes.

THE WARNING SIGNS
Here’s what should ring alarm bells:

TYPE 1
Extreme thirst • Frequent urination
Constant hunger • Blurred vision
Sudden weight loss • Nausea
Vomiting • Infections
Extreme tiredness


TYPE 2
Excessive thirst • Frequent urination
Feeling tired and lethargic
Slow-healing wounds
Itching and skin infections
Blurred vision • Mood swings

GESTATIONAL
Pregnant and over 30 years of age
Family history of Type 2 diabetes

Overweight
Certain ethnic groups including Indian, Vietnamese, Chinese, Middle Eastern, Polynesian/Melanesian, indigenous Australians
Gestational diabetes in previous pregnancy
Previous problems carrying a pregnancy to term

COMMON MYTHS

Myth 1: Sugar causes diabetes.
Wrong. Type 1 diabetes is thought to be caused by genetic factors combined with environmental triggers. Type 2 diabetes is caused by a combination of genetic and lifestyle factors. People with diabetes do need to limit foods that are concentrated sources of sugars, but they can eat small amounts of sugar.


Myth 2: People with diabetes can’t eat chocolates or sweets.
Small quantities of chocolates and sweets are occasionally OK as part of a healthy eating and physical activity plan.


Myth 3: People with diabetes have to eat special foods.
Like everyone, people with diabetes have to eat healthily. That means a diet low in saturated fat and high in fibre and whole-grain foods.


Myth 4: You can catch diabetes.
Diabetes is not contagious.


Myth 5: People can have a “touch of diabetes.”
You can’t have mild or borderline diabetes. All diabetes is serious and, if not managed properly, can lead to serious complications.

The India You Don’t Know

By M H Ahssan

Travellers in India usually have their itinerary all mapped out—it’s generally the tried and tested routes. The Golden Triangle (Delhi-Agra-Jaipur) or Goa. And since unstable Kashmir is out, Kerala is in. That is an Indian holiday in a nutshell. There are a few who do special interest tours.

Lakshadweep and Andamans for the diving, Kipling Country for jungle safaris, the Buddhist pilgrim trail, the heritage train rides. But beyond these busy pockets, there is a vast treasure trove of secret places.

Talk to any Indian about a favourite childhood memory and he or she will wax poetic about their “native place.” Ponds they used to swim in, fruit eaten straight off the tree, family feasts, temple festivals. They may also speak of memorable holidays to special destinations, often very close to home but still unexplored, preserved as if in amber. Here are seven spots off the tourist map but well worth seeking out.

Lucknow, Uttar PradeshFor Mumbai-based model Ashutosh Singh, Lucknow is home. “Whenever I return, it’s as if I’ve never been away. There is an old world courtesy unique to my town.” He says that the frantic development that characterizes other Indian towns hasn’t altered Lucknow’s essential structure. The Old City still preserves the fading glories of this capital of the Nawabs of Awadh.

Towering gates, domes and arches define the cityscape. Even the Charbagh railway station looks like something out of the Arabian Nights. There are also charming havelis with intimate courtyards and interconnected rooms, just like the one where Ashutosh’s own family still stays. In the evenings people would stroll out unhurriedly to socialize over Lucknow’s famous chaat, sweets or paan.

Many of Lucknow’s iconic landmarks have made their presence felt in films like Umrao Jaan and Shatranj ke Khilari:

The Bara and Chota Imambaras, Rumi Darwaza, the labyrinthine Bhool Bhulaiyaa, Chattar Manzil and Jama Masjid. The Bara Imambara complex, which also houses the famous maze, is essentially a Shia Muslim shrine. This grand project was undertaken by 18th-century Nawab Asaf ud Daula to generate employment during a time of famine. While the common people worked during the day, the equally impoverished but unskilled nobility were secretly hired to destroy what was constructed during the night, so that the task would continue till the crisis was over. He was the general architect of much of what we see today. “The magnificent Lucknow University buildings are an architectural marvel, with a vast campus,” says Ashutosh, “I’m proud to have studied there.”

Delhi-based writer and filmmaker Vandana Natu Ghana fell in love with Lucknow while she was a student there. She recommends the old markets of Chowk and Aminabad for delicate shadow embroidery (chikan), rich zardozi and badla work in silver and gold threads. This bustling area also houses the legendary Tunde ke Kebab shop, over a century old. “You can base yourself in Lucknow and do some fascinating day trips out of the city. Barabanki, with its ancient Mahabharat connections, and Malihabad, famous for its mango orchards, are redolent of a bygone era and only 25 kilometres away from the city centre,” she suggests.

There is also the village of Kakori, which has given its name to silken smooth kebabs, created to indulge a toothless nawab. Lucknow is also very much a gourmet destination. Vandana, who has an Army background, advises that I not miss the British Residency, said to be haunted by ghosts of the 1857 Mutiny and siege, and the long drive through the cantonment area to the War Memorial, fringed by laburnum and gulmohar trees. “In summer, the road becomes a carpet of red and yellow flowers. People tend to visit Delhi, Agra and Varanasi and bypass Lucknow altogether. They don’t realize what they’re missing,” she sighs.

Kasauli and other cantonment townsI have always liked cantonments. They stave off rampant development, preserve heritage structures and are often in beautiful locations. If you’re interested in old churches, military graveyards and history, you will definitely have a sense of stepping back in time.

Married to officers of the Indian Army’s Gurkha Regiment, Naji Sudarshan and Daphne Chauhan live in Delhi, but have had homes in cantonment towns all over the country. “It is a world all its own,” says Naji. “We are a stone’s throw away from chaotic towns and crowded metros, but the instant you enter Army territory, everything is disciplined and beautifully maintained.” A cantonment town is a time machine. And still properly British. You need a dinner jacket to dine at clubs where the menus have been the same for generations. Gardeners maintain seasonal flowerbeds with military precision and since wooded areas are protected, you find an astounding variety of birdlife.

Self-contained cantonment towns like Ranikhet, Lansdowne and Deolali have a quaint character all their own. Foreigners are not permitted to visit Chakrata in Uttarakhand, which is a restricted access area while Mhow, near Indore, is actually an acronym for Military Headquarters of War. There are artillery and combat schools, sanatoriums, military colleges and regimental headquarters scattered through all of these.

Army families keep getting posted to far-flung stations, but everything remains reassuringly familiar within the cantonment. “So while you get to discover a different place every time you are transferred, the set-up never really changes. Cocooned within the Army, you couldn’t be more secure,” adds Naji.

Kasauli in Himachal Pradesh is one of Naji’s favourites, a flower basket of a hill station with its typical upper and lower mall roads, a delightful bazaar and Victorian cottages with roses around the door. It is also across the hill from Subathu, where the Gurkha regiment has its headquarters. Daphne returned recently to Wellington, home of the Madras Regimental Centre in the Nilgiri Hills, where they had been posted 20 years ago. “Nothing has changed. It is still the same sleepy town, with perfect weather. Yet it is close enough to the social whirl of Ooty,” says Daphne. “A good place to base yourself for treks and tea gardens. Not many hotels, but there are home stays and farms in Wellington as well as in nearby Coonoor.”

Ashtamudi, KeralaAshtamudi is a sprawling expanse of water, the second largest and deepest wetland ecosystem in Kerala.

Like an octopus, it is eight-armed (ashtamudi literally means eight locks of hair). Vembanad (which includes Kumarakom) is larger and much promoted by Kerala Tourism, but lesser known Ashtamudi has much to offer. All the canals and creeks of these backwaters converge at Neendakara, a hub of the state’s fishing industry.

For Naresh Narendran, a rubber businessman in nearby Kollam (formerly Quilon), Ashtamudi is home territory. “Unlike the other backwaters, you see dense stands of coconut trees, rather than the usual scene of rice paddies,” he says. “There are also sand bars in the estuary which fishermen use. From a distance, it looks like the man is actually walking on water.”

I remember visiting an uncle whose backyard extended to the water’s edge. We could buy karimeen (pearl spot fish) and river mussels straight off the fishing boats. For fresh coconut water or toddy, a man would be immediately despatched up a coconut palm. Much of what we ate was picked from the kitchen garden. Naresh himself is proud of his own “little farm” not far from here, where he experiments with varieties of banana, yam, fruit, and vegetables. This is quintessential, picture-postcard Kerala with palm-fringed lagoons and dense tropical vistas in a hundred shades of green. “You could rent a boat and go around,” suggests Naresh. “But there are commuter ferry services to Alleppey at a fraction of the cost, which will give you much the same views.”

The much-photographed Chinese-style fishing nets of Cochin are seen around Ashtamudi as well. You could use the ferries to visit neighbouring islands, villages and lesser-known towns in and around the backwaters, much as the locals do. There are temples, sacred groves and churches to discover. Water birds like cormorants and herons abound. “I love photographing the backwaters in its many moods. In the monsoon it is quite spectacular,” says Naresh. “A few resorts are coming up here but it is still largely unspoilt.”

Kollam itself is a historic port town worth exploring. The coir and cashew industries made it prosperous but it was well known on ancient trade routes. Marco Polo came here, as did Ibn Battuta, the famed Islamic scholar and traveller. Not far from Kollam town is Thangassery, a little Anglo-Indian enclave that was once settled by both Dutch and Portuguese colonizers. It has a layout reminiscent of towns in Goa, beaches and a stately lighthouse. But the Anglo Indian community which gave it much of its character has largely emigrated.

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.