Quality Healthcare in ‘Lean’ manufacturing way

Lean is a production practice that considers the expenditure of resources for any goal other than the creation of value for the end customer to be wasteful, and thus a target for elimination – Wikipedia

Delivering quality healthcare in countries like India is really challenging due to lesser affordability of patients with lesser doctors. Aravind Eye care made made its first attempt to radically change this by adopting McDonald’s hamburger approach to eye care. I have provided YouTube video below which talks about this innovation. Also in my innovation series, I called out Narayana Hrudayala who has taken similar approach to cardiac surgery. Recently I visited Shankara eye hospital in Bangalore, where I saw similar approach. Across all these healthcare organizations I see the following things in common:

  1. The hospital is primarily started as a charity by setting up basic infrastructure with the vision of providing quality healthcare at an affordable cost
  2. In order to make the operations in a sustainable, they need to ensure hospital cost is optimized to the maximum extent by reducing waste at all levels
  3. Since patients can be charged only minimal, they need to operate in volumes (ex: in terms of eye checkups, eye operations etc…) with quality built in every step. Number of doctors are limited, who anyways cannot handle higher volume.
  4. In order to handle the volume problem, doctor’s time spent with per patient needs to be optimized. This can only happen by making him as a key decision maker by looking into diagnostics information/data rather than starting with basic questions in each and every patient.  In order to achieve this optimization (for example, in case of eye-care),  the whole eye check-up, initial eye diagnostics, getting problem statement and checking medical history etc are handled by well trained para-medical staff so that doctor only spends time for decision. Thus every doctor will be able to see more patients per day, thereby addressing the volume problem.
  5. Since paramedical staffs are trained only on a specific activity very well and they only do that activity, quality is inherently built into the system. Paramedical staff salaries are lesser than doctors so the overall cost is also optimized

In summary by reducing non-core activities of doctor and optimizing it, multiple health care organizations in India are able to deliver affordable healthcare. In manufacturing world Lean manufacturing talks about various elements (like waste reduction, value creation, value stream mapping, Just-in-time production etc..), which is exactly getting implemented by Indian healthcare giants so consistently, so well! I would say this is a lean manufacturing approach to healthcare, not sure why this is not so popularly spoken about in the media.

Fallout of Airtel and its customer service

When the going gets tough, the tough get going. This seems to be truer in case of Airtel.

I have been Airtel’s loyal customer more than a decade now, ever since I took my mobile phone connection. Few years later I have taken broadband + telephone connection as well. In both cases their customer service was really good, always used to have great experience in every other interaction of support. For example they have surprised me even during a normal phone call, which I wrote in post titled ‘A great customer experience’. However over the years their service quality is consistently taking toll. During 2011, I again wrote a post titled  Irate customer – A lost opportunity, where I called out painful experience I had with Airtel, while resolving some issues related to Jwritings domain.  Over the past two years their service level even gone down, which I heard from many of my friends who have Airtel connections.

My recent experience was awful when I visited them to get my mobile rate plan changed. Even after spending 30 face-to-face minutes with customer service representative he couldn’t even locate which rate plan I am currently using. My objective was to convert my plan into a corporate plan, so that I can bring down my monthly rental as the corporate plan seem to offer more benefits in terms of free minutes. The issue hit the roof when I asked him about my current data plan, when the customer service representative enlightened saying “Sir, till 2 GB data limit, you can download anything from the Internet. However after that limit you can only browse the Internet”. This guy doesn’t know the difference between browsing and downloading from the Internet. I thought I will forget my computer science fundamentals if I continue to stay in their showroom.

Definitely Indian service providers are under tremendous cost pressure due to various issues (Regulatory issues, scandals, ARPU challenges and maintaining healthy top- line etc.) in telecommunication sector. In order to meet these challenges, Airtel looks like subcontracting customer facing services to third party providers who are ruining customer relationships.

Ten types of Innovation – Concluding notes

With article on Bigbasket, the ten part innovation series comes to an end. When I understood the innovation types (created by Doblin) way back in 2011, my idea was to apply it from Indian context and make case studies fitting various types. It took two long years for me to complete this series with decent satisfaction.

Innovation has gone beyond building a particular product or service. By building something different doesn’t guarantee a business success, whereas ensuring customer derives value will. India, unlike some of the developed countries, is in the cusp of transformation where we have both traditional old school thinking and new school of thinking co-existing with each other. This made my inquiry to innovation all the more interesting. As and when I observed some innovative way to serve customers, I started mapping them back to Doblin’s model and came up with this whole series spanning across industries.

Please find URLs to individual posts as follows:

BOOK REVIEW: My journey – Transforming dreams into action

Abdul Kalam
Transforming dreams into actions

Author: APJ Abdul Kalam

Price: 195 INR

For most Indians, reading about Abdul Kalam and his work is always an inspiring item. Post retirement, he started off his journey into writing by scripting his auto-biography titled ‘The wings of fire’, followed by some popular books like Ignited Minds, Envisioning an empowered nation, Turning points etc. Most of them talk about his early life in Rameshwaram followed by his experience with various defense and space research organizations. Another popular theme in these book is about “Vision 2020”, where Kalam is been articulating India becoming super power by 2012 by achieving excellence in technology, rural transformation, self reliance and self sustainability.

In this latest book ‘My journey – Transforming dreams into Action’, Kalam has followed pretty much the same canvas but gone into very small and specific stories. Unlike his previous books, he has chosen real life anecdotes and shared deeper learning from them. Growing up in town like Rameshwaram with very high aspirations and dreams is not very easy situation to handle. With lesser resources and exposure, Kalam need to go thru lot of struggle and build his career brick-by-brick. The most inspiring part is about him overcoming umpteen numbers of challenges and overcoming them with very strong vision and value.

For example, he explains how he became a working person at the age of 8 by supplying newspapers in Rameshwaram and struggle associated with it. Every day he would to get up at 4 AM followed by his morning tuition and prayers. In order to support his family Kalam takes a part time job of distributing newspapers to Rameshwaram household. Thanks to some policy change, Chennai-Dhanushkodi passenger train which carried daily newspaper bundle from Chennai removed Rameshwaram station from the list. This resulted in Kalam doing every day stunt by catching paper bundle thrown from a moving train at Rameshwaram station. Kalam will then go on distributing them after which his school day would start. In the evening he would finish his homework and complete settlement of newspaper daily account with his cousin who gave him this opportunity. It was quite obvious to see the amount of stress and pressure he might have gone thru as a 8 year old boy, but the way he put it across along with key learnings is simply amazing.

There are multiple similar stories related to his profession filled with struggle and failures.  Inspired by the vision of Dr. Vikram Sarabhai, Kalam and his team went on building Indian space story from the scratch.  He recalls how his professional career is similar to his early life in Rameshwaram – Lesser resources, Limited knowledge, larger challenges and a passion to win. Taking references from Bhagavat Gita to Thirukkural, Kalam mentions how he taken inspiration from these great ancient text to lift him up when things went wrong due to mistakes.  There were some repeated stories (ex: Church in Thumba becoming ISRO office, thanks to the local people), however they are always inspiring ones to hear again and again.

Unlike his previous books, Kalam kept this one very simple which can even read and understood by a high school kid. Definitely worth reading!

Innovation – Type 10 – Customer experience innovation [Case: Bigbasket]

Bigbasket
Bigbasket

The tenth and final type of innovation is around customer experience, which is all about creating a superior experience to customer’s entry to exit. In India many players attempted to do online grocery store for quite some-time now. It is extremely challenging business in Indian context (logistics, poor roads, unpredictable traffic, varying climate conditions etc…), which Bigbasket is able break by creating very good customer experience around it. I have personally tried and tested this many times, it works all the time with great experience.

Simple and effective User interface

The first thing that impressed me about Bigbasket is their simple and effective user interface. It was very easy to search/navigate for individual grocery items and create an order in a hassle free manner. Every item contains optimal information (neither too less nor too much) with put me into ease. Also when individuals go back for re-ordering, it keeps previous list handy for modification, which saves time for second time. This works very well for monthly grocery ordering.

Prompt alerts

While building an easy to use user interface might look relatively easy, integrating with backend supply chain to meet the promise is super critical. Especially in India, where the probability of providing prompt service is less (due to inherent challenges like infrastructure) providing prompt alerts to customers about the order status creates a lot of trust. In case of Bigbasket I get regular alerts (both in form of email and SMS) about my order status. Just before the final delivery of goods, authentication PIN is provided via SMS, so that both delivery person and customer can be assured about delivery.

Service delivery guarantee

Bigbasket
Bigbasket

After placing order, customers get to choose the time-slot in which they wanted the goods to be delivered. This super critical item (similar to Flipkart’s cash on delivery service) which helps office goers to get goods delivered at a convenient time. Their interface also shows the current booking status and slot availability in order to help customers choose the proper delivery time. From execution point of view, I have always seen they deliver goods on the time promised.

Return policy and wallet

During delivery, in case of item mismatch (ex: quantity) or damage (ex: broken seal), Bigbasket delivery folks take it back without any questions. Upon entering these items in backend (using Mobile application) customers again get immediate notification about when the updated item will be delivered. In case of item return, the money is kept back in a digital wallet which can be adjusted for next purchase.

In summary right from order placing to goods return, Bigbasket has done massive integration and prompt execution of their service. This gives a great end-to-end experience for customers in terms of quality, on-time delivery and reliability.

Innovation – Type 9 – Brand [Case: Decathlon India]

Decathlon
Decathlon

It’s time to catch-up with ten part innovation series. The Ninth type of innovation on Brand is about how offerings are expressed to customer to their benefit. It’s been quite a bit of challenge to identify a right case for this innovation, finally nailed it with Decathlon sports India. Decathlon entered India as a sports goods retailer, primarily catering to high end customers by having closed membership association. This was partly due to their positioning and partly due to retail industry regulations in India. Over a period of time they changed the way their brand is expressed to customers, which has made Decathlon as a popular brand today.

To start with, Decathlon instrumented making their employees as brand ambassadors by hiring sports enthusiasts for specific departments. Say if you are passionate cyclist, then you will be hired and made as cycle department sales person or supervisor. Naturally this makes a huge difference to a customer who walks into the shop to buy a bicycle. Given the pre-existing expertise and passion, naturally the sales person will understand customer needs better and ensure they are suggested with proper options in comparison with the person who don’t know anything about cycles. Added to that these employees are positioned well in their marketing communications, hoardings and future job hire needs.

The store and employee appearance also establishes a unique brand image among customers. Unlike other stores, Decathlon’s real estate size is relatively large in order for customers to try out various sports goods (ex: cycles). However they ensured their internal store arrangement (ex: racks) is very simple with lesser investments in order to optimize cost. One gets ‘no-nonsense-I-get-what-I-want’ feeling by entering any of their stores. Their employee appearance (ex: French beard with trendy hair-style) is also something different that I have observed in comparison with other places.

When Decathlon entered India, it was not open to all retail customers. One needs to get membership in order to shop from them, which got repositioned now. It is not open for all retail customers. By targeting upper-middle customer segment, they are able to establish Decathlon as a synonym for quality with decent pricing. This repositioning and communicating right message also changed the way Decathlon is perceived among common people.

In summary Decathlon changed the sports expression by innovating around their brand – in terms of store design, employee appearance, profile of employees and positioning. Globally they have been existing for more than three decades, but by adapting to some of the local challenges, they are well positioned their brand in sports goods retailing.

Audiobooks – New mode of learning

I have been a regular reader of books over years now. Every year I used to read 12 books (one book a month) until 2012. Last year it was very challenging to keep up with work expectations, family priorities, travel and fitness related activities. Definitely I was missing books not sure where and how I will make time for it.

I stumbled upon audio-books in a book-store, thought of giving it a shot. Thanks to Bangalore traffic I at-least end up spending anywhere between 1 to 1.5 hours in traffic, where listening to FM radio or audio CD becomes boring after some time. I have interleaved it with Audiobooks, which has opened up new mode of learning. Following are the pros and cons of Audio-books.

Pros:

  • Excellent way to catch-up with book reading in a busy schedule added with traffic jams. After getting into the habit of listening, longer traffic jams have become an opportunity for me to listen to few chapters from audio-book.
  • Compared to physical book reading, audio books are faster. Based on my experience, I was able to complete one book in a week (with 7-8 hours of drive time). This definitely provides a ‘feel-good’ factor!
  • Easy to carry, share and store. Obviously they occupy less space inside and outside house, I am able to create a small sharing circle in office where we keep exchanging audio-books.

Cons:

  • Audio book listening experience cannot equate book reading experience. Especially during driving, I was not able to give 100% concentration on what is being told from the audio system. This also sometimes gives a ‘incomplete’ feeling
  • Relatively I found good audio books are costly than printed edition. At least in India, average book audio costs about 500 INR, which is quite high, compared to print edition. Of course it varies from book to book
  • Continuously listening to audio books creates a ‘boring’ feeling especially during long drives. It is good to interleave audio books with good music and radio. I found a decent combination of these three worked well for me.

Resources:

Book retailing: Traditional v/s online

Recently I had a casual conversation with owner of a large scale book store. His is a family owned business, been in book retailing for decades with great passion for reading. Upon further discussions he mentioned about his book retailing business heading south (for months together) due to the emergence of e-commerce portals like Flipkart. It is quite obvious that e-commerce portals enjoy benefits of on-demand inventory, lesser operational costs (ex: rental) and direct supplier relationships helps to offer a better price. Added to that, most of Indian e-commerce portals are backed by heavy funds from venture capitalists, which help them to provide un-realistic discounts on books with additional benefits like free shipping, cash-on-delivery etc. Over a period of time, these e-commerce portals build valuation for the company based on number of transactions and incrementally grow by bringing more products (apparels, electronics, toys etc…) thereby becoming online mega store. On the other hand, traditional book retailers are struggling to keep up their operations with increasing rental/labor costs, overhead of inventory and limitation of not able to offer higher discount as it will affect their bottom line.

As a matter of fact this problem is not new. In countries like US e-commerce portals (likes of Amazon) took away significant market share from traditional book stores but some of them re-invented themselves and survived this challenge. I was wondering what Indian book stores (considering Indian context) can do to compete fiercely online bookstores. Here are some of my ideas which can be considered:

  • Similar to book stores of the west (ex: Barns and Noble) traditional book stores should re-shape themselves as modern libraries by creating a compelling reading experience around it. Readers should be compelled to walk in, take a look of their choice and spend hours in the shop by going thru their favorites. By adding additional factors (like coffee shop, comfortable table & chairs for reading, offering sample chapters for free etc…) these book shops can attract regular visitors who will potentially end up buying these books
  • There are some specific types of books (ex: Children books) come in various shape, size and weight, which is still not comfortable to buy online. As a parent I spent lot of time considering these aspects before buying book for my daughter by physically visiting the shop. Such type of books still has a lot of ‘touch-and-feel’ factor associated with it. Traditional retailers should think of some special promotions and tie-ups to push these books thru young parents and readers
  • Among adult readers (both fiction and non-fiction) there is a strong possibility to build a community based on common interest. Such communities combined with social media can be made as early adapters of new releases and share their viewpoints in terms of face-to-face get together, sharing book reviews, meeting authors directly and exchanging book related practical experiences. Such community should be provided with special discounts and covered under loyalty programs, thereby attacking clusters
  • Even now many of the traditional shop owners are expecting customers to physically walk into the shop and order for books. This should be changed by adapting home delivery based on phone order, building a micro-site for the bookstore where alternative channels of reaching out to the customer. Such new channels should be backed with excellent customer service in terms of delivery time and quality to re-invent the whole business.

I am not sure if any of the traditional book store owners got necessary mindset to re-invent their business by adopting new ways to sell books in this digital era. Unless they adapt to this change and re-invent the way they do business, it is going to be extremely difficult to survive.

Aakash (Ubislate 7Ci) review


Aakash - Ubislate 7Ci - Review

I purchased Aakash few months back, thought of writing review on multiple aspects. To give a background, Aakash is an ultra low-cost tablet innovated and manufactured by DataWind. This organization also partnered with Government of India for distributing Aakash with subsidized option for school students, which is expected to transform education. My main requirement was to have an ultra-low cost tablet for my four year old daughter, mainly for viewing videos from YouTube. I was not bothered about anything else, so the requirement was very simple and straightforward.

Purchase experience

Pros – Made an online purchase from Datawind’s website (http://www.ubislate.com/) by placing order for Ubislate 7Bi model which comes with resistive touch screen with 3000 INR. Since they operate with razor thin margin, there is no credit card option. Only debit cards are accepted for free shipping. If you are paying by cash (on delivery), additional purchase charge is added. Overall purchase flow was smooth similar to popular ecommerce websites.

Cons – Please don’t go by the service level guarantee they claim in website (ex: 48 hour shipping). I got a call-back after about two weeks of placing the order regarding confirmation. The call center executive by default started talking in Punjabi + Hindi mixture as they are based out of Amristar. Surprisingly executive mentioned Ubislate 7Bi is out of production, but they will ship me an upgraded version (Ubislate 7Ci with capacitive touch screen) with no additional cost. I happily opted for it; shipment reached me a week later. Totally it took three weeks of shipment time. Some of my friends also mentioned about delayed shipments. So if you are looking for faster shipping with immediate use in mind think twice before opting for Ubislate.

User experience:

Overall build quality and packaging looks good, especially considering ultra low-cost option.     Ubislate 7Ci comes with 7″ touch screen, Wi-Fi interface, 512 MB RAM with Android ICS (v4.0.3), which matches my requirement of YouTube viewing using home wireless Internet.  Typical device sign-up is done with Google ID worked seamlessly. I was able to immediately install many applications from Google Store, without any major problem. The out-of the-box experience was really good.

However after using the device for some time, I observed applications took long time to load, even basic browsing became a pain. On a frequent basis, I need to use their “killapp” option to clean up unwanted processes to free up some memory. By default all applications gets installed into device internal memory, by moving some of them into external SD card (comes with 2 GB storage) made my device reasonably faster.  Battery backup also very poor, device hardly works for 2-3 hours at a stretch. Many occasions I found booting screen doesn’t show up after charging the device and I ended up doing “plug-and-pray”. This also makes me wonder if the device would ultimately stop functioning some day or the other!

Transforming education?

Aakash was projected as the tablet for transforming education in India by using ultra low-cost plus internet connection as a “one-stop” solution. I have serious concerns on how it can really help school students. Given the not-so-favorable user experience (mainly power backup & speed) adding, slower internet connection (especially in rural areas) would make the experience even worse. By the time I write this post, there are enough and more articles in the web about how this device is already failing big time in mass market adoption. Even though there is a definite market opportunity, once again bad execution failed to capitalize the opportunity. It will be another version of Simputer story.

Bottom line – Don’t buy this device, I am repenting for buying it. My daughter is not using it at all, continue to use home computer or smart phones for watching YouTube!

82.5% of indian technical graduates are not ready to be employed, but who’s listening???

I came across a recent report which claimed that only about 17% of Indian technical graduates are ready to be employed.

From my experience it is usually about 6 to 12 months before a fresh Engg graduate gives more to the team than he or she takes. Most of what is taught in Engineering degree is pretty much useless or irrelevant. In fact if I have to go back to my 4 year Engg syllabus and re-look what part of what I learnt (or was supposed to learn) has been useful in my 20 year career, it would be a very low percentage.

Now coming back to the survey, based on the track record, the response from the industry would be on the following lines:

Decry the deplorable levels of tech education and write long petitions to the Education Ministry to improve the quality and relevance of our tech degrees and how this is impacting the industry. After all this, continue their existing hiring policy of campus recruitment and have a graded starting salary based on the ranking of the college.

Im fairly confident that none of the big hirers from our IT services sector is going to change their hiring policy in any manner. They will continue to hire Engineers every Engineering college that they can lay their hands on, put them through a long training process before the candidate is ready to contribute anything meaningful.

If 82% of them are unfit and you anyway have to put them through a few quarters of training, why bother with the degree in the first place? Why not just take in students who have just completed their high school, put them through a 1 or 1 1/2 year training instead of hiring fresh Engineers and training them for 6 months before they are ready?

While this does sounds extreme, this is exactly what a Chennai based technology product development company has been doing for the past 4 years now. I understand about 15% of their 1300 work force is actually from their own University and they expect to raise it to 30% over the next few years based on the current strength in their University and their hiring plans. I believe their 18 month course has been designed keeping in mind the needs of and expectations from a “Software Engineering Trainee” in their company. Roughly 95% of the students from this University have been absorbed into their company and the “graduates” from their University are actually more “job-ready” than fresh graduates who have spent 4 years in an Engineering college.

Of course there are other dimensions to this company’s initiative – they hire disadvantaged high school pass outs who would otherwise not be able to afford our super expensive (but inefficient) education system and are willing to take this “chance”. The students are paid a nominal stipend and are free to “drop out” anytime from their University – during or after the course.

Its high time that our IT industry looks at such innovating means of fulfilling their resource needs than relying on a system that delivers 82% unfits and believing that the government / education system “owes” them better trained people. Nobody owes anybody anything.

This would also put an end to people believing that they can start an Engineering college if they just have 50 acres of land in the middle of no where and turn out unfits who would be hired anyway.

NWritings