Adapting Available IT Technology In Early Assignments
“How long does a customer have to wait to get the blood report of her child so that her doctor can start treatment?” we asked the team at the medical diagnostic centre.
“8-12 hours; very often till the next day.”
“So, since the customer needs a fast result, let’s target to complete this in 25-30 minutes”.
In 1993-94, when we started on our journey to help organisations implement Business Process Reengineering, one major limitation was the low level of technology-adoption by most of the organisations that we had to work with at that time. The few that had PC desktops used them as typewriters/word processors for the correspondence of senior managers, and to store data and documents as a backup, along with conventional paper files for the same. Hence the paperwork was always the first activity before the same material was entered into the PCs. Each PC was a standalone entity used in different departments and hence the same data was re-entered from one PC to another using paper documents as reference. Occasionally floppy diskettes were used to copy and transfer the data from one PC to another. But this wasn't considered adequate and reverification would be done using the paper trails which were the basis of conventional working.
The Local Area Network (LAN) was just being introduced in the market and hence we were able to suggest using this technology to connect the multitude of the PCs, so that data moved seamlessly across the organisation within the same premises. Dial-up modems were available; using them and File Transfer Protocols we organised movement of files and data across different locations. The Internet was just being talked about and it was not available across the country nor was it cheap where BSNL had introduced it. DOS was still the operating system commonly used and PC ATs with Windows were just being introduced. Mobile phones were yet to enter the market and when they did they were too costly to use. But pagers were available at quite a reasonable cost and in some cases we used them to help communicate between the office and field staff. As the technology evolved in both PCs and Mobile phones, and the Internet became affordable and ubiquitous in later years, we were able to help organisations adopt these technologies to implement BPR.
Between Raghav, my associate, and myself we adopted the dial-up modem and PCs to share important documents and created a virtual office between us. We also agreed that, depending on who has the primary contact with the prospective client, the proposal would be made by him and the other would join as a principal associate. And we were maintaining zero overhead operations between us, working from our home office, fashionably called SOHO (Small Office Home Office) in those days. We started using our own example to show how work simplification is the essence of BPR and why it could easily be adopted in an organisation to improve business performance without adding additional resources in terms of manpower and office space. The only investment needed was IT hardware and the corresponding software. And both were undergoing phenomenal changes very fast and hence we had to keep in mind what was coming in the future while helping the organisations to come up with redesign ideas.
In this background, I will proceed to share the story of how we got prospective clients interested in our proposal. By 1994, the paperback version of the book, Reengineering the Corporation, by Hammer and Champy was available in the local book stores. We bought a copy of the book before meeting a prospective client. We made it a point only to approach the CEO or MD of a company as our first point of contact, since we believed only a motivated person at the top could spearhead the kind of massive change initiative called for in BPR. This is where our personal contacts and network helped in setting up such first meetings with them. We also knew that if the top man was not sold on the idea on our first meeting we would not get another opportunity. So we decided to use the book as a sales tool.
After a brief introduction about what we had done with our early clients and the kind of results obtained, we presented the book to the CEO and requested him to read the book first. And we told him that if he was charged up after reading the book we would meet him again to discuss the way forward. Practically every one of them contacted us 48 hours later saying that they could not put down the book once they started reading it, and saw possibilities from the book for their organisation to adopt. In the meanwhile, they also ordered additional copies of the book and shared it with their senior executives so that they also came on board before calling us for a discussion on the way forward. We found that, in many cases, we were hired even before we discussed pricing and other terms of a contract!!
Since we were based in Hyderabad, we decided to focus on this market. We contacted some prospects where we had done some work before. In my case, I had worked with Apollo Hospitals and Nagarjuna Finance earlier and we called on them both while our assignment with Hyderabad Batteries was still going on. The MD of Nagarjuna Finance, a leading NBFC at that time, was so charged up after reading the book that he called us immediately for an assignment to streamline their deposit mobilisation process. While the ideas for reengineering got finalised quickly by the team, they got caught up with problems of IT implementation. The investment in hardware was not an issue, but the software had to be developed afresh and the IT chief was very kicked with the prospect of doing a pioneering job and said his team would work on it themselves without any outside help. However, they were struggling to come up with the software fast enough, since there was a constant churn of software people at the working level and we believe the competence level of the chief was also not enough to address the issues.
One fine day, the IT head quit his post and migrated to Australia and the company simply abandoned the project instead of looking for outside help. This was the first assignment where we realised that we must have a good external IT vendor to back BPR projects.
However, the Apollo Hospital case was a major success story. Since I had known the MD, Sangita Reddy, from my previous work, we could easily get to meet her, and she was very excited to hear about how BPR could be adopted. In the Hammer and Champy book, there was a case study of implementing BPR in a hospital in the USA, and we also managed to get hold of many other such examples which were available. After reading the book, she called us to make a presentation to the top management team consisting of the Chief Medical Officer, Medical Director and herself, who were the key decision makers. It was a post-lunch presentation and we were quite disappointed when we noticed both the CMO and Medical Director, being older men, dozing off occasionally, and we thought we had blown an opportunity.
As we expected, when we met Sangita Reddy a few days later, she said the BPR exercise had been discussed with other senior staff too, and they felt that the disruption that such an intervention would cause to patient care was too severe to go forward, however excited she herself was.
Dejection! But we didn’t want to give up and kept the discussion going. And, during the conversation, we discovered that they had an offsite centre in the heart of the city where a diagnostic clinic was run with a small out-patient department where doctors were available for consultation. This was also used as a catchment centre for referring serious cases to the main hospital. The diagnostic centre was providing diagnostic services to patients referred by various city doctors located in the vicinity. Being part of Apollo Hospital, it had a high-profile image and was very much in demand for both OP consultation and diagnostic services. Seeing an opportunity here, we requested Sangita Reddy to let us explore what we could do there, since there would not be similar high-profile doctors to oppose this “disruption of their work”.
This centre was headed by a young man who had studied hospital administration in the USA and returned to India and was working for Apollo Hospital. Based on his background and experience, he was given independent charge of this centre. Like any other diagnostic centre, they had various departments starting from reception to cashier, sample collection and testing labs and other radiological labs like X Ray, ultrasound and cardiac care testing facilities like ECG, ECHO, TMT, etc. Patients requiring CT Scan and other more sophisticated facilities were referred to the main hospital. It was no different from any such stand-alone lab located across the city. The centre also had housekeeping staff and a few administrative personnel to provide typing and other related support.
When we first went to this location and looked around, we frankly had no clue at all about what we could change dramatically, as called for in BPR. This was a set-up like all others in the city -- indeed, in the country -- where patients arrived with prescriptions for various tests, got their samples taken by the staff, and went back home, to return a few hours later, or the next day, to collect their neatly typed-up reports, so that they could show these to their doctors and start a line of treatment. We had both gone through this process ourselves numerous times, very often for the ailments of our young children.
But we waded in, regardless, somehow knowing some inspiration would come our way...
We formed a cross-functional team (CFT) consisting of the receptionist, a sample collection technician, a technician from the labs, the typist and a housekeeper. The members of our team were some of the junior-most persons in the organisation and they were initially bewildered about being in any kind of improvement exercise. Most of the existing procedures were established by the heads of their departments who were located in the main hospital, and it was difficult for the CFT members to even see the shortcomings in the processes that had been well set for years. And when we said that they should come out with ways to dramatically improve such processes, all of them worried how any such move would be received by their bosses!
Seeing this early, and in order to soothe their nerves, we got Sangita Reddy herself to come and talk to them, assuring them that she was leading this project, that she expected great results, and no harm would come to any of them. They had never met her face-to-face before, and this meeting was a big morale-booster, so that we could take the assignment forward.
After the mandatory (for us) initial joint reading of the book by the team, we got them to collect information on their current way of working, including a lot of statistics. All data was manually entered in large ledgers -- there were no computers at this location. Despite this, we got a reasonable measure of information fairly quickly, since it was also supervised by the young manager in charge of the centre. We also got the team to track a sample number of actual patients from the moment they entered the centre till they got their final report, and record what happened in each case.
When the team put together all this information, we encouraged them to look at the entire process from the patient’s (customer’s) view-point. How would they feel if their child was running a high temperature and they had to wait a day to get a diagnostic report and start the appropriate treatment? But the present way of working was deeply ingrained in them and they could see no options.
Then we brought out the concept of “Which steps in your process are of real value to the customer?” It didn’t take them long to list sample collection, lab analysis and report-typing as the only things the customer wanted. Once they focused on these three operations, they also soon concluded that sample collection and report-typing were each a matter of minutes. What about the lab analysis? It slowly emerged that, for perhaps 80-85% of tests, the actual testing time was also in minutes.
Thus emerged the challenging goal: In 80% of cases, customers should come in, give their samples, have a cup of coffee in the cafeteria, and go home within half an hour with their report.
I am not presenting the details of the redesign here since it involves some proprietary information; suffice it to say that they came out with a great and credible process redesign. We then told them they had to prepare and make the presentation to their management themselves -- youngsters who had never spoken before an audience before! To add to their terror, Dr. Pratap Reddy, the legendary Chairman of Apollo Group, happened to be in Hyderabad that day and invited himself to the event.
But, despite the stuttering and nervousness of the team, their redesign ideas came through clearly. Dr Reddy, who was himself looking for revolutionary change in his fast-expanding group of hospitals, was blown away and, when he learned that a computer needed to be installed as part of the redesign process, he immediately told the team to “steal” one from anywhere in the main hospital and get on with their new process. In just a few weeks, the team could proudly proclaim their uniqueness among the dozens of diagnostic centres in the city.
The diagnostic report process being one that everyone has experienced, we made a presentation of this case a part of our initial presentation to prospective clients to make them understand the power of BPR to bring about dramatic change.
This experience boosted our confidence to take this approach to more organisations which were much larger than the ones we had worked with till then. And that opportunity came when we got to work with Glaxo India in 1995-1996, which also catapulted us to get more work from large corporates across India.
I will share the progress of this journey in my next post.
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