Sunday, July 10, 2011

Excellence of a different kind…

This happened in Hyderabad, India…

My friend from Dubai is on a visit and has a serious stomach upset, thanks to indulging himself in some of this city’s spicy local food.   I take him to the private clinic of a popular local physician.  We find a long line of patients waiting for the Doc’s attention.
Now, this Doc does not give appointments and just serves patients in the order in which they show up.  For convenience, a chaprasi (typically, an uneducated helper) issues patients a token with a serial number as soon as they come in, and asks them to be seated.
The token given to us is #24.  The number currently being attended to is #5, indicating that we may not be called in for over two hours.  We decide to go to another doctor down the street, when the chaprasi stops us outside the office.  “Don’t worry sir, I can help you go in earlier” he says respectfully.  He also gives us an expectant smile, which most Indians recognize as a request for a bakshis, or tip.
Intrigued, we stay back.  True to his promise, the attendant returns with a different token (#11).  Collecting our #24 from us, the chaprasi assures us our number will be called in less than 20 minutes.

After waiting for 30 more minutes, we are fed up and accost the chaprasi.  The chaprasi very apologetically pleads that the patient inside is taking unusually long.  He however, promises to send us in along with the next patient.  When the next patient is due, he asks us to ‘join the party’ of two others who are going in to meet the doctor – for all intents, as part of that patient’s family!   We are then asked to stay back in an ante-room till the patient, whose turn it really was, is done.

Eventually, we manage to see the doctor in less than 40 minutes since walking in.  The Doc himself is thoroughly professional and treats my friend with the greatest expertise and care.  Not only does he hear my friend’s case patiently, he shows a total familiarity with my friend's condition and is able to prescribe just the right medication for his condition, assuring him of total relief in less than ten minutes.  He also takes time to discuss life in Dubai and throws in a complimentary ‘emergency’ pill should the prescribed medication not work in the promised ten minutes!

No expensive tests or scans.  Simple clinical diagnosis and spot-on medication!  My friend was so totally reassured by the very demeanor of the Doctor, he perhaps did not need the medicine!  We come back, ‘delighted’ with the experience – the Doc, the service and the chaprasi!  The latter, of course earned his tip.

I suspect many Indians may not be surprised with this story.  Examples of such innovations, not only in customer service, but also in product / service development abound in India.  I dare say, this may be the case in many parts of Asia.  What is even more intriguing is that most of the nearly 40 patients the Doc sees every day, actually come out very pleased with his services; which explains their willingness to wait patiently (sic) for over two hours for his attention.

Yet, as a “process professional”, I hate to concede that this was a show of process excellence!
Got me thinking.
There are two parts to the overall experience.  The process of expediting the waiting experience and the consultation itself.  Let me skimp over the consultation -- as I am no medic -- except to say that there was no attempt to capitalize on the excruciating pain the patient was in and the doc showed a thorough understanding of my friend's condition, and experience in handling such cases!

Coming to the process of waiting, of course, there was the dubious ethics of playing with those waiting in line.  Take away ten points for that!

I think what the clinic achieved was a deep insight into it's customers that enabled it to segment them: Those who can afford to wait and those who could not.  Possibly elementary for a seasoned marketing pro, but for a doc, I’d give 25 points right there!

Taking off from here, I guess a typical management student would recommend two separate queues for the two segments, possibly charging a premium for those in a hurry.  Another solution may have been to open a different clinic in an up-market location and / or split his working hours / days between the two.  However, given the income diversity of the location, as well as the potential extra cost of opening another clinic, these strategies would certainly not have fared well.  Moreover, given the local culture, such a practice, so long as it is carried within discreet limits, would not be seen as outrageous!

Floor mill on a scooter - a classic jugaad
I doubt if it was the doctor’s idea to introduce the ‘token exchange’ or even the ‘patient coupling’ systems.  It could well have been the genius of the helper, looking for an extra buck.  This is a classic case of what, in India, has come to be known as jugaad.  There’s a lot of literature, at least on the internet, on India’s jugaad.   If you are interested, you can make a beginning here: and

Don’t get the impression that I am happy with the dubious ethics displayed by the chaprasi.  My point is that jugaad is actually ethics-agnostic.  The ‘jugaadu’ just focuses on a workable solution, given the constraints.  One may add ‘ethical solutions only’ as an additional constraint, and he may well come up with something equally clever.

Let’s look at the HR aspect as well.  How does one hire and retain such enterprising people in such a small setting?

While our doc’s innovative helper could be a fluke, typically, such assistants – often called by their pet names -- are long-serving employees.  Sometimes they may even be linked to employer-families for generations.  Any written agreement or ‘appointment letter’ would be unthinkable!  The wages are typically ‘at market’, with a variety of freebies thrown in.  These could include emergency loans, medical assistance, pass-me-downs and more.  Often, they are treated as the ‘poor cousin’ and as such may even be privy to many family secrets.

This does not mean there is no attrition. It would not be shocking to hear a long serving helper, very apologetically, tell his boss that his cousin from Dubai has arranged a job for him and he would like to leave!  And there are cases, where the boss would actually help him along with a big loan or parting gift.

One may argue such arrangements are more in the nature of personal relationships than employment contracts.  I would submit otherwise.  For, the basic purpose of the relationship is clear.  One has a job that the other wants to take up -- for a consideration.  The relationship that is built (sometimes quite rapidly) is a matter of increasing mutual trust and concern for each other’s welfare.  I know this sounds rather utopian, but to my mind that is the core element at the heart of the relationship.  And yes, many have also come to grief due to this.