As one gets sick, distressed and tired of reading day in and day out the impact and implications of the meltdown in the global economy, global terrorism and other related aspects one thing is certain to happen – irrespective of whether or not the depression is as deep as the early 1930’s the number of people who are going to be extremely depressed is going to significantly higher!
The news item on the increase by nearly 30% of the anti-depressant drugs in India and the long waiting lists for appointments with counselors is a clear indication of that.
The increasing corporatisation of the healthcare industry for a multitude of reasons with the simultaneous increasing awareness amongst all segments is bound to bring the healthcare service providers under pressure from multiple fronts. The publication, in a business magazine, of a leading Delhi based hospital being accused of medical negligence causing the death of senior functionary from an industry confederation is a sure pointer in this regard. Even as I write this another news items that has been in the circuits is about the death of a 25 year old who participated in the clinical trials in a southern metro. The issue of regulatory monitoring in the sphere of medical diagnostics has been a major cause for concern amongst the medical fraternity. There have been reported incidents of patients test reports reflecting significantly varied readings from different laboratories. That by itself does not mean anything as one was not sure if the test results represented readings from the same sample or samples taken at different points of time! Irrespective of what the truth is, the fact remains that there has always been an element of doubt in the minds of the users if there are any controls on these establishments. One would be surprised to know that the medical diagnostic laboratory, in most parts of the country, operates under the Shops and Establishment Acts of the state. The fact that healthcare is a state subject has compounded to the problem. The Clinical Regulations Bill 2007 referred to the select committee in the parliament may not see the light of day before the term of current Lok Sabha.
Healthcare organisations in that context would do themselves good by embarking on a structured risk management strategy to deal with the multiple risks that they are exposed to. Organisational and professional reputation is going to be at stake. The quantum of risk is accentuated by the fact the process and service structure is significantly more complicated than a normal business process. The medical responses in each individual case could be significantly different but implications of the same enormous. One is reminded of the old joke of a mechanic removing the cylinder heads from the motor of a car of a famous heart surgeon in his shop. The mechanic after fixing the car straightened up, wiped his hands and asked argumentatively, "So doctor, look at this. I also open hearts, take valves out, put in new parts, and when I finish this will work as a new one. So how come you get the big money, when you and me is doing basically the same work? “The doctor leaned over and whispered to the mechanic and said: "Try to do it when the engine is running".
Any normal business organisation represents a plethora of inter connected complex process wherein on must expect and be prepared for something to go wrong. The implications of that in the context of healthcare organisations are profound. The role of paramedics and other support staff is extremely critical for successful outcomes. More often than not, it is at this interchange that things go wrong. The recent years have seen a number of good accreditation standards in the context of healthcare organisation being introduced. Some of the more prominent include that for hospitals in the form of the National Accreditation Board for Healthcare and Hospitals (NABH), both large and small, Laboratories (NABL), Blood Banks and more that have released targeted organisations wellness clinics that now covers practically the whole of the residual medical services other than hospitals. These have to a large extent adopted the already well accepted international systems like the JCI (Joint Commission International) USA or the Australia Council for Healthcare Standards (ACHS). Accreditation apart healthcare organisations would do well for themselves in embarking on implementing these well defined systems to ensure that their risks are minimized atleast from an operational perspective.
Without delving on the standards and its focus, one area that any healthcare organisation should definitely address is its management of sentinel events. Risks that healthcare organisations are exposed to are even more pronounced considering it has implications from a customer perspective, employee perspective, and the brand not to speak of just financial aspects. Sentinel event being defined as any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a person or persons, not related to the natural course of the patient's illness. Organisations like the JCI or ACHS have already defined many of these and have data and statistics of their occurrence. A healthcare organisation need not necessarily have to reinvent the wheel by trying to identify these. However, as the saying always goes act global think local - customization of these events to local conditions is a mandatory must. One may not have reported events, in the international scenario, of bodies being handed over to the wrong person; surgery on the wrong person; new born getting burnt in the incubator or a now born bitten to death by ants! A well defined and structured system to deal with sentinel events is definitely warranted.
The other aspect that needs attention in the current context is the ability of hospitals to manage public emergencies. The UNIDO document on the management of public emergency definitely warrants attention by organisations. The recent incidents in Mumbai definitely warrant the need for more structured response at hospitals to public emergencies be it natural disasters or man-made. The ministry of health should make it mandatory for all healthcare organisations to establish and practice responses in respect of public emergencies. The clinical regulations bill should also make it mandatory for all healthcare organisations to report defined sentinel events including near misses so that the data could be used by other organisations to review their own processes and initiate preventive actions.
The corporatisation of healthcare organisations not to speak of the large public hospitals in the area of public charitable trusts has meant that the stakeholders in these organisations have gone up manifold. The public awareness to medical negligence has also gone by quite a bit. The management team should equip itself to deal with situations in more comprehensive manner. Implementation of process based systems is extremely critical. Organisations need to implement these systems from a more holistic perspective and not merely an accreditation point of view. Even the accreditation needs to be from a constructive point of view and not a critique representing the personal views. Organisations should also clearly recognise the fact that accreditation or certification is only the beginning and not go back to old times post the event. This is particularly true in India where the system needs to continuously monitored and audited with the active participation of the senior management team till the system is completely and comprehensively internalised.
Friday, December 26, 2008
Monday, December 8, 2008
Succession Planning & Governance
Even as one stands paralysed with disbelief at the happenings around us, another stark fact begins to hit you harder. The absolute lack of foresight or a sense of urgency that exists at various levels on the need for succession plan to deal with contingencies be it in an emergency or otherwise.
How else would one explain the situation where the financial capital of the country has been hit hard, the home minister and the chief minister have either resigned or shown the door but the decision makers are have sat and procrastinated for whole week trying to identify their successors? The moot point here is that if the state did not require the key functionaries at this point of time then did they ever require them! Is this the time for us to exhibit our classical indecisiveness?
This is not the first time that we have observed this situation, be it an emergency or normal time. We have had innumerable occasions in the past wherein key posts at regulatory bodies or heads of institutions where the incumbent tenure was completed and the successor not nominated until the last moment or positions kept vacant for day, weeks and months. On the one hand, we have a policy that rightly stipulates that senior positions require that the candidates should have minimum residuary service of atleast two years but then the same policy does not provide that the succession should take place well in advance so that the succession is seamless and complete. The case in point is that succession planning is being ignored as a key governance issue at all levels be it public administration or at various levels in corporate. We are excellent in fire fighting, for we created it and then have a false sense of pride when flames are doused.
Succession Planning is not a will
Succession planning is not be equated to that of a will or a last testament. The will or the last testament would be one of the components of an effective succession plan. Succession planning is not be made only the context of a retirement but needs has to be made in the context any emergency be it temporary unavailability to permanent vacancy for whatever reason. The quality of leadership would largely be determined by the fulfillment its obligation on leadership matters. The existence of well-conceived and defined succession plan can go a long way in enhancing the confidence levels for all the stakeholders and can be an enormous source of reassurance.
Well-defined process
A well-orchestrated succession plan should to exhibit a lot of thought, planning and above all execution. There are definitive principles enunciated for the process of a succession plans. Amongst them include - Identifying the right leader at the right time; It is leadership driven collaborative process; It is a continuous process; constantly ensuring that the pool in churned for size and quality and circumstances; It should be driven by a carefully articulated strategy.
Succession planning is a dynamic and creative process. It would belittle the process to reduce something very significant to a formula. A few basic rules do apply. To begin with, the leadership team should take responsibility for “Ownership” of the succession planning. The plan should be reviewed and updated at least once a year. The plan should contain key elements like an assessment of the organisational management requirements; an assessment of the strengths and weaknesses of the incumbent head and others in the existing hierarchy; identification of potential internal candidates and above all an interim transition plan, particularly where there is no clear internal successor and a separate emergency crisis management plan with designated internal interim successors.
Viewed in the context of above requirements, it would observed that more often than not the succession plans are driven by adhocism, crisis management of the poorest quality driven by events that could have easily been identified and addressed with great ease.
A debate on succession is definitely bound to evoke passionate debates on whether the successor needs to be an insider or should be lateral selection from outside. One can never give a opinion on this that a perfect fit in all circumstances. An insider would definitely be the choice if the organisation is already on good growth path and it just requires management. On the other hand if organisation requires a transformation or a dramatic shift in strategy an outsider would be a more appropriate choice.
No discussion on succession planning would be complete without a discussion on the need for mentoring. An effective succession plan, amongst others, would necessarily have to address the need for grooming of the identified successor. Mentoring can be the one of most effective and efficient means to bridge the current and future. It does not require outside facilitators or trainers as it builds on the internal strengths. It is more often than not the most institutionalized process of transfer of knowledge, often be the single most important goal of a succession-planning program. It would be giving a new sense of purpose to the older generation of being recognised as it lets them know that they are valued. It can provide a renewed energy and motivation as they are in the last lap of their professional career. As far as the identified successor goes it gives him a great opportunity to use an old horse as a sounding board and can take the decisions under well-controlled conditions for decisions are bound to be monitored and reviewed to ensure that impact of wrong decisions are minimized.
Succession planning is an inevitable process that has to be addressed except if one is willing to risk the peril of postponing the inevitable. Family run organisations sometime need it more as the seniors find it hard to cut the proverbial umbilical cord. Cricket buffs would recall the famous words of Graham Yallop the stylish Australian batsman who retired at the peak of his career and wrote in his memoirs that was better to quit when people are still asking why rather than why not”!
How else would one explain the situation where the financial capital of the country has been hit hard, the home minister and the chief minister have either resigned or shown the door but the decision makers are have sat and procrastinated for whole week trying to identify their successors? The moot point here is that if the state did not require the key functionaries at this point of time then did they ever require them! Is this the time for us to exhibit our classical indecisiveness?
This is not the first time that we have observed this situation, be it an emergency or normal time. We have had innumerable occasions in the past wherein key posts at regulatory bodies or heads of institutions where the incumbent tenure was completed and the successor not nominated until the last moment or positions kept vacant for day, weeks and months. On the one hand, we have a policy that rightly stipulates that senior positions require that the candidates should have minimum residuary service of atleast two years but then the same policy does not provide that the succession should take place well in advance so that the succession is seamless and complete. The case in point is that succession planning is being ignored as a key governance issue at all levels be it public administration or at various levels in corporate. We are excellent in fire fighting, for we created it and then have a false sense of pride when flames are doused.
Succession Planning is not a will
Succession planning is not be equated to that of a will or a last testament. The will or the last testament would be one of the components of an effective succession plan. Succession planning is not be made only the context of a retirement but needs has to be made in the context any emergency be it temporary unavailability to permanent vacancy for whatever reason. The quality of leadership would largely be determined by the fulfillment its obligation on leadership matters. The existence of well-conceived and defined succession plan can go a long way in enhancing the confidence levels for all the stakeholders and can be an enormous source of reassurance.
Well-defined process
A well-orchestrated succession plan should to exhibit a lot of thought, planning and above all execution. There are definitive principles enunciated for the process of a succession plans. Amongst them include - Identifying the right leader at the right time; It is leadership driven collaborative process; It is a continuous process; constantly ensuring that the pool in churned for size and quality and circumstances; It should be driven by a carefully articulated strategy.
Succession planning is a dynamic and creative process. It would belittle the process to reduce something very significant to a formula. A few basic rules do apply. To begin with, the leadership team should take responsibility for “Ownership” of the succession planning. The plan should be reviewed and updated at least once a year. The plan should contain key elements like an assessment of the organisational management requirements; an assessment of the strengths and weaknesses of the incumbent head and others in the existing hierarchy; identification of potential internal candidates and above all an interim transition plan, particularly where there is no clear internal successor and a separate emergency crisis management plan with designated internal interim successors.
Viewed in the context of above requirements, it would observed that more often than not the succession plans are driven by adhocism, crisis management of the poorest quality driven by events that could have easily been identified and addressed with great ease.
A debate on succession is definitely bound to evoke passionate debates on whether the successor needs to be an insider or should be lateral selection from outside. One can never give a opinion on this that a perfect fit in all circumstances. An insider would definitely be the choice if the organisation is already on good growth path and it just requires management. On the other hand if organisation requires a transformation or a dramatic shift in strategy an outsider would be a more appropriate choice.
No discussion on succession planning would be complete without a discussion on the need for mentoring. An effective succession plan, amongst others, would necessarily have to address the need for grooming of the identified successor. Mentoring can be the one of most effective and efficient means to bridge the current and future. It does not require outside facilitators or trainers as it builds on the internal strengths. It is more often than not the most institutionalized process of transfer of knowledge, often be the single most important goal of a succession-planning program. It would be giving a new sense of purpose to the older generation of being recognised as it lets them know that they are valued. It can provide a renewed energy and motivation as they are in the last lap of their professional career. As far as the identified successor goes it gives him a great opportunity to use an old horse as a sounding board and can take the decisions under well-controlled conditions for decisions are bound to be monitored and reviewed to ensure that impact of wrong decisions are minimized.
Succession planning is an inevitable process that has to be addressed except if one is willing to risk the peril of postponing the inevitable. Family run organisations sometime need it more as the seniors find it hard to cut the proverbial umbilical cord. Cricket buffs would recall the famous words of Graham Yallop the stylish Australian batsman who retired at the peak of his career and wrote in his memoirs that was better to quit when people are still asking why rather than why not”!
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