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 Dr
Devi Shetty believes that "managing success is
not a problem, anybody can do that. But in the long
term if you want to be successful, you have to learn
the art of managing the failures." He should know
because not only is he one of India's most successful
cardiac surgeons, he has also set up four of the country's
best heart hospitals.
In his next book, out later this year, C K Prahalad,
the world's leading management theorist, tells the story
of how new age Indian entrepreneurs are challenging
conventional wisdom on how businesses should be run,
and hence, could become role models for companies around
the world in their effort to cut cost, improve quality
and remain competitive.
Prahalad believes there is much that businessmen in
the US and elsewhere can learn from the alternative
business models perfected by the likes of Sunil Mittal
of Bharti and Air Deccan's Captain
G R Gopinath. Also in the list of entrepreneurs he has
been studying is, uniquely, a 52-year-old cardiac surgeon
from Bangalore, Dr Devi Shetty, and his Narayana Hrudayalaya,
the hospital he runs on the outskirts of the city. Shetty
had made national headlines a few years ago when he
operated on a Pakistani child free of charge. This in
a small way contributed to the thawing of relations
between the two countries.
But what attracted Prahalad to Dr Devi's hospital is
the fact that it charges a flat fee of less than Rs
70,000 for heart bypass, which is less than 50 times
of what a US hospital would bill any patient. Still,
the hospital's failure rate is less than half the American
average.
It also operates on hundreds of infants each year for
free, and yet is highly profitable and has no debt.
The hospital provides health insurance for 25 crore
poor Indians for a premium of as little as Rs 5 per
head per month. Narayana Hrudayalaya also runs 39 remote
clinics and mobile-testing labs, which are linked by
satellite to the Bangalore facility as a result of which
patients can be treated across long distances.
As much as he believes in charity, Shetty is also an
ardent believer in market economics. Prahalad termed
his method of running his hospital as 'radically innovative'
in an interview to American magazine Business Week early
this year. Shetty's hospital runs like an assembly line
operation using the best equipment in the world. Surgeons
do three or four operations a day, which according to
Shetty, leads to fewer mistakes and fatalities. Besides,
the expensive hospital equipment is used 14 hours a
day, seven days a week, leading to economies of scale.
Narayana Hrudayalaya's 25 or so foreign-trained surgeons
who came back to India for the love of working here
get paid far less than they would have been if they
had continued working in the US or Europe. All this
leads to efficiency at a very low cost, and that is
the secret behind the hospital's profitable balance
sheet.
Shetty's philosophy of work is based on his belief that
quality health care need not be expensive and that it
can be brought within the reach of the poorest of poor.
In an e-mail to Man's World, Shetty writes: The problem
of health care is that it is linked to affluence. Unfortunately,
pain is not negotiable. You can always postpone your
decision to buy a new car or a new house. But when you
are in pain you need instant relief. Unfortunately,
health care is reaching out to a very small fraction
of the people of this planet. For example, 100 years
after the commencement of heart surgery, less than eight
percent of the world's population can afford it. For
92 per cent of the people living on this planet, heart
surgery is a distant dream. We need to look at a different
model for health care delivery keeping in mind the affordability
of the common man. Our entire business model is based
on that. We believe that every man, woman and child
in this planet has to contribute a tiny amount of money
like Rs 5 or 10 a month for their health care. If this
happens, this world will have a wonderful health care
delivery system.
"We believe that 200 to 300 bed hospitals are economically
not viable. We need to build health cities with 5,000
beds where all the expensive services and knowledge
are shared. Knowledge and experience are very expensive
and rare commodities. These talented people, if they
are given an opportunity, will share their wisdom with
20,000 outpatients in a day. That is the best thing
that can happen to the health care industry, and the
cost of their service will come down significantly.
We should not look at 10 per cent or 20 per cent cost
reduction in health care; we should be looking at 80
to 90 per cent cost reduction. If we utilise the intellect,
wisdom and knowledge we had in developing fantastic
tools like the mobile phone and internet ...if a tiny
portion of that, is spent on developing a concept for
delivery of healthcare, then this world would be a wonderful
place to live in."
With this kind of thinking, it is no wonder that Mother
Teresa always turned to him whenever her heart threatened
to give way. He would take the first available flight
to Kolkata and rush to the home of the Missionaries
of Charity to meet his "greatest inspiration".
At his sprawling office at Narayana Hrudayalaya Hospital
City, it's her photograph that graces the wall behind
his burnished teakwood desk, with Vedic chants playing
softly in the background.
He speaks with messianic zeal and passion about health
care and the poor. He operates free of cost on those
under twelve, and of his 13,000 plus operations in a
17-year career, over 5,000 operations have been on children.
For him, compassion is everything. "If I am given
a choice, I would like to treat only poor patients.
But unfortunately, economic reality does not allow me
to do that."
That he enjoys demigod status is clear the moment he
steps into the hospital lobby in the morning. Patients
and relatives dive for his feet, and this embarrasses
him no end.
 Shetty
was the first surgeon in the country to perform neo-natal
open-heart surgery. He performed the first open-heart
surgery in the world to close a hole in the heart with
the help of a microchip camera. He used an artificial
heart for the first time in India and performed the
country's first surgery using the blood vessels of the
stomach to bypass the blocked arteries of the heart.
He launched India's first telemedicine program in collaboration
with ISRO in the northeastern states and the revolutionary
Yeshasvini Health Scheme in association with the Karnataka
government that enables farmers and their families to
get treatment for a variety of ailments by registering
and paying just Rs 5 per month.
Noble Laureate Amartya Sen was so impressed with this
health care insurance scheme with its one crore plus
members, that he's suggested it be made available across
India.
Born in Mangalore, Shetty was the eighth child in a
family of nine children. Shetty says that being among
the youngest at home taught him that it is wisdom that
matters, and not size or age. "With so many relatives
around the house, I learned how to adjust, compromise
and win over to get what I wanted," he says.
He decided to become a doctor after seeing the recurrent
illnesses of his parents. "My childhood was spent
with the fear of losing my mother. My father, a diabetic,
had multiple episodes of diabetic coma. During my childhood,
God was a distant image. In fact, the clear image in
my mind was that of a doctor who could save the lives
of my parents."
Another childhood incident left a lasting impression
on his young mind. "On a Saturday afternoon, I
was trying to build a car out of matchboxes and sticks.
My mother was speaking to our distant relative in Bombay.
This lady was telling my mother about a surgeon who,
apart from saving her child's life, also offered his
service completely free of cost. I could hear my mother
blessing the mother of that surgeon for giving birth
to such a wonderful person and ended up saying that
this world is still a wonderful place because of people
like him. That was the time I found the purpose to my
life, the purpose of bringing happiness to all the children
of this world."
Educated and trained in general surgery at the Kasturba
Medical College, Mangalore, Shetty moved to England
in the early 1980s where he trained in cardiac surgery
at the West Midlands hospital. This was followed by
his appointment at the famous Guy's Hospital in London.
"I was a good learner but realised it would be
difficult for me to make it big given the biases."
But one day, the chief surgeon couldn't make it to the
operating theatre in time for a major operation and
Shetty was ordered to go ahead. He conducted the complex
surgery with ease and went on to become one of Guy's
finest surgeons. Having accomplished his goal of being
the 'best', he decided to return to India in 1989 and
soon established the BM Birla Heart Research Centre
in Kolkata for the Birlas and later, the Manipal Heart
Foundation in Bangalore for the Manipal Trust.
This was in the late 1990s when Bangalore had already
become the hub of the indian IT industry and the media,
which was looking for poster-boys in other fields, homed
in on the personable Dr. Shetty. In a span of two years,
dozens of articles were written on him in the national
and international media. Brand Shetty, however, discovered
that fame comes at a cost and that he suddenly had many
detractors, within his profession and the management
of the hospital he worked for. He doesn't wish to comment
on this, except to say that "One must follow the
dictates of one's heart. There is always a higher calling
and one must not be stumped by one's detractors."
Towards the year 2000, he decided that it was time to
move on, "to become independent." The result
was the Ravindranath Tagore International Institute
of Cardiological Sciences in Kolkata in 2000 and the
Narayana Hrudayalaya at Bangalore soon after. Despite
his growing fame, setting up his own hospital was not
easy. "I look at myself not long ago struggling
to get a loan to start our first heart hospital in Kolkata,
without asking for assistance from my family members,"
he says.
"It was a real uphill task to convince the bankers
to invest in my project. Today we can come up with projects
for hundreds of crores and the bankers are more than
willing to fund it. This is what I call the unfair advantage
of people who are successful. So, it is very important
you use those unfair advantages for the welfare of mankind."
His two hospitals now account for as much as nine per
cent of all heart surgeries done in India. Shetty feels
if he were to raise that number to around 25 per cent,
he should be able to negotiate directly with the surgical
equipment manufacturers and bring down prices by half,
the benefits of which can be passed on to the patients.
He calls it the "Wal-Martisation of health care."
The innovative hospital management methods that he followed
has obviously made him wealthy, but he says he ploughs
much of it back into his work. "We hail from a
very conservative south Indian family and are used to
spending very little on ourselves," says Shetty.
"We also spend quite a bit of our money on developing
projects without any return. For example, right now
we are working on a model of rural health care in Amethi
(Uttar Pradesh), where we're in the process of creating
16 rural clinics and in the near future, a health insurance
for villagers to attend this clinic and get free medicine
for a premium of 50 paise per month."
Shetty's theory is that there is about a 60 per cent
possibility of success and a 40 percent possibility
of failure for every new project he starts.
If he feels that the failure chances are more than 50
per cent, he does not take the plunge. "Since we
are mentally prepared for failure, we take all the measures
to cover ourselves, so that it will not surprise us
and it will not deprive us," he says,
"I spend a lot of time addressing children and
during my entire talk, I talk more about coping with
failures than managing success. Managing success is
not a problem, anybody can do that. But in the long
term if you want to be successful, you have to learn
the art of managing failures, since failure is part
of growing up and every failure makes you a wiser man.
The wisest man is the one who does not repeat the steps
he has taken to fail."
Dr Shetty's new project is to build a government-private
sector partnership to create a Health City on the outskirts
of Bangalore that will offer sophisticated treatment
for every disease and attract patients from all over
the globe. It is part of a dream he has for India: "I
am convinced that within the next 5-7 years, India will
become the world's largest mass health-care provider.
Every procedure on the human body will be done in a
different manner and that will be defined by Indian
medical specialists. Every man, woman and child of India
will carry a smart card, which will give each of them
access to high technology health care with dignity.
India will dissociate healthcare from affluence, just
like what has happened with mobile communication. India
may not become the richest nation in the world, but
it will definitely become the happiest nation in the
world."
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