1

MANIPAL -
THE TRANSFORMATION STORY
by
Rashmi Mutt & Sandhya Ramesh

www.greatplacetowork.in
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Manipal Health Enterprises, today is a leading multi-specialty healthcare organization, with 15

hospitals and clinics located across the continent. With a workforce of over 5300 employees, it aims
to provide affordable tertiary care that follows a multispecialty healthcare framework. The foundation
of this conglomerate has been built on its values of clinical excellence, patient centricity and ethical
practices. Was this their story 27 years ago? Let’s find out!

QUICK FACTS:
15 hospitals across Asia
The challenge extended to business6,000
as well asbeds
people. It was centred around how to focus on growth
Consolidated
and profitability, keeping the service-orientation Turnover
alive. Come of INR.
2012, Manipal 1600
found itself Cr.
at the peak
The challenge extended to business a
of its strategy re-engineering across the 10 hospitals. and profitability, keeping the service-
Diversified Services in Home Care, Information of its strategy re-engineering across t
That time, they were faced with business challenges like:
Centre, Ambulance Rescue Service, Robotic That time, they were faced with busin
Business Challenge What did this mean?
Scale up revenue TheySurgery, IBM
were at 853.86 Watson
crores. Business Challenge What
The Early Days Improve customer The net promoter’s score, a key organizational health index was at 68– up revenue
Scale They
experience with lowest scores on F&B and the Discharge process.
Improve customer The n
Control uncertainty in daily Daily operations were being affected by incidents caused due to
Manipal Hospital was founded in 1991, as anurses’
operations. trustee-owned healthcare
agitation, loss of talent, provider.
and inability to As
attract the right typethe years
experience with l
Control uncertainty in daily Daily
of talent.
progressed, Manipal realised that to cater to the widespread need for world-class healthcare operations.in the nurse
of tale
country, it would be important to spread its wings over multiple regions. By 2005, the hospital had
By now, Manipal had realized that to become a differentiated healthcare provider, the internal
organically grown its network of hospitals
customers also need to and extension
be aligned centres,
towards its vision but was
of Partnership model.still
A fewconcentrated
common people in and
By now, Manipal had realized that
related challenges cited by leaders were:
around parts of South India. customers also need to be aligned to
related challenges cited by leaders we
High attrition in the nursing department owing to better opportunities available
A Sudden Shift abroad and the emergence of new healthcare operators in India.
High attrition in th
In 2005, to spur growth, key leaders atLack
MHEPL strategized
of collaboration that
between the toand
clinical expand their
non-clinical network, they would
workforce. abroad and the emergenc

follow an “acquire and integrate” model.

Challenging to attract good talent for key roles, as hospitals were not perceived as a Lack of collaboration
preferred employer for growth opportunities.
However, this required a mammoth change; one that could not take place overnight. One thatChallenging to attra
preferred employer for gr
involved a transition - from a Paternalistic model to a Partnership framework.

In a Paternalistic model, the hospital continues to operate in the form of a Trust, providing
P a g e 2 | 6 affordable

healthcare with reasonably upgraded infrastructure and technology. However, in a partnership model,
it is critical for every partner hospital to conduct daily operations keeping in mind, investment in
Clinical Excellence as well as Technology, so they can provide world-class care to a larger pool of
patients. MHEPL was thus faced with a new challenge – how to keep the element of trust between
its partner hospitals and people, while moving up the value curve?

The Industry Struggle:

To provide world-class treatment and care, hospitals need to make continuous investment in areas of
R&D and upgradation of technology /infrastructure. The healthcare scenario in India appeared gloomy
back then (continues still). There was only 1 hospital bed available for every 1000 citizens, whilst the
World Health Organization recommends an average of 2.9 beds.

In 2014, as per India Today reports, the healthcare sector had very poor Doctor: Patient ratio, which
was at a dismal 1:2000, and the Indian Government’s spending on healthcare, was only around 0.5%
of its GDP. According to an article published by Economic Times, this sector presented very few
growth opportunities and hence there was a deficit of required as well as trained skills, specifically
physicians, laboratory professionals, nurses and paramedics. In addition, the younger generation
was not drawn to this sector, thereby leading to a further shortage of talent and manpower.
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With 50+ years of presence as an entity, Manipal wanted to seize this opportunity to grow and serve
the community at large. By 2012, it had expanded its network of hospitals to 10, and was embarking
on acquiring hospitals in the rest of the continent.

The challenge extended to business as well as people. It was centred around how to focus on growth
and profitability, keeping the service-orientation alive. Come 2012, Manipal found itself at theThe
peak
challenge extended to business a
of its strategy re-engineering across the 10 hospitals. and profitability, keeping the service-
of its strategy re-engineering across t
That time, they were faced with business challenges like:

Business Challenge What did this mean?

That time, they were faced with busin
Scale up revenue They were at 853.86 crores. Business Challenge What
Improve customer The net promoter’s score, a key organizational health index was at 68– up revenue
Scale They
experience with lowest scores on F&B and the Discharge process.
Improve customer The n
Control uncertainty in daily Daily operations were being affected by incidents caused due to
experience with l
operations. nurses’ agitation, loss of talent, and inability to attract the right type
Control uncertainty in daily Daily
of talent.
operations. nurse
of tale
By now, Manipal had realized that to become a differentiated healthcare provider, the internal
customers also need to be aligned towards its vision of Partnership model. A few common people
related challenges cited by leaders were: By now, Manipal had realized that
customers also need to be aligned to
related challenges cited by leaders we
High attrition in the nursing department owing to better opportunities available
abroad and the emergence of new healthcare operators in India.
High attrition in th
Lack of collaboration between the clinical and non-clinical workforce. abroad and the emergenc
The Journey Towards One-Manipal
Challenging to attract good talent for key roles, as hospitals were not perceived as a Lack of collaboration
preferred employer for growth opportunities.
However, come 2014, Manipal found itself amidst critical challenges: Challenging to attra
preferred employer for gr
Business Challenge What did this mean?
Increase revenue growth They were at INR. 853.86 crores.
Page 2|6
Improve customer The net promoter’s score, a key organizational health index was at 68
experience – with lowest scores on F&B and the Discharge process.
Control uncertainty in daily Daily operations were being affected by incidents caused due to
operations. nurses’ agitation, loss of talent, and inability to attract the right type
of talent.

The challenge did not lie just in integrating and standardising the quality of service across the
numerous acquisitions they had performed over the years. The challenge extended to both; the
business as well as people. Every hospital they acquired came with its own, unique culture. One that
could be very different from what was already existing at Manipal. Some of their People challenges
were:

People Challenge What did this mean?

Attrition in Nursing Trained nurses were leaving for better opportunities abroad/ in new
healthcare operators.
Diverse interests Lack of collaboration between clinical and non-clinical workforce.
Industry & Employer Brand Inability to attract good talent for key roles, as hospitals were not
perceived as a preferred employer for challenging careers.
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Therefore, seven years later, although they had grown by 10 hospitals, MHEPL had to now start
focusing on integrating the acquired hospitals into their vision of One Manipal!

To understand employee sentiments better, as well as to focus their effort in the right areas, Manipal
undertook the Great Place to Work® survey in 2014. The key highlights from the survey were:

The challenge extended to business as well as people. It was centred around how to focus on growth
and profitability, keeping the service-orientation alive. Come 2012, Manipal found itself at theThe
peak
challenge extended toI business a
of its strategy re-engineering across the 10 hospitals. and profitability, keepingMthe service-
S That time, they were faced with business challenges like:
of its strategy re-engineering across t
P
T That time, they were faced
R with busin
Business Challenge What did this mean?
R Scale up revenue They were at 853.86 crores. O
Business Challenge What
E Improve customer The net promoter’s score, a key organizational health index was at 68– up revenue
Scale V They
N experience with lowest scores on F&B and the Discharge process.
Improve customer E The n
Control uncertainty in daily Daily operations were being affected by incidents caused due to
G experience with l
operations. nurses’ agitation, loss of talent, and inability to attract the right type M Daily
Control uncertainty in daily
T of talent.
operations. E nurse
H N of tale
S By now, Manipal had realized that to become a differentiated healthcare provider, the internal
customers also need to be aligned towards its vision of Partnership model. A few common people T
related challenges cited by leaders were: By now, Manipal had realized
S that
customers also need to be aligned to
related challenges cited by leaders we
High attrition in the nursing department owing to better opportunities available
abroad and the emergence of new healthcare operators in India.
High attrition in th
Lack of collaboration between the clinical and non-clinical workforce. abroad and the emergenc

Challenging to attract good talent for key roles, as hospitals were not perceived as a Lack of collaboration
preferred employer for growth opportunities.
Challenging to attra
preferred employer for gr
Keeping in mind the business need, as well as the current industry challenges; the HR Department at
Manipal designed new strategies in the areas of Hiring, Training & Career Development, Rewards &
P a g e employees.
Recognition; to attract key talent, develop top performers as well as retain seasoned 2|6

Ekta – Innovating Through Collaboration

One such initiative was Ekta. As part of Ekta, task-force teams come together, to pick up key business
issues. During the survey conducted in 2014, one of the employees shared; “There are many people
who can deliver at much higher levels of potential; empower them, trust them, side-lining them is not
the solution.”

With the objective of empowering its people to take decisions and continuously improve processes,
groups of employees designed, presented and implemented solutions through a structured and
guided process. There were numerous Lean-out workshops conducted under this umbrella. For
example, just by applying Lean Six Sigma to the nursing handover process, the team reduced handover
time in the Nursing department.

Hospitals Existing Handover New Handover Efficiency

Time Time
Goa 98 minutes 35 minutes 64.29%
Jaipur 60 minutes 30 minutes 50%
Bangalore 66.53 minutes 43.4 minutes 34.77%
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Not only did this improve the efficiency, but it also impacted the overall customer satisfaction scores
positively.

Mr. Pramod Alagharu, CEO, Manipal Health Enterprises Dwarka Pvt. Ltd., spoke gravely about having
a discharge process so cumbersome; not only was is it leading to high dissatisfaction of customers, it
was also leading to loss of revenue. He went on and then described the efforts of an Ekta team, that
devised solutions which reduced the discharge time by half, for all transactions.

Customer Satisfaction Scores 2014 2017 Impact

Discharge Queries 77.23 89.96 12.73
Discharge Process The challenge extended72.93
to business87.13 14.2
as well as people. It was centred around how to focus on growth
Discharge Time and profitability, 75.01 88.97
keeping the service-orientation 13.96
alive. Come 2012, Manipal found itself at theThe
peak
challenge extended to business a
of its strategy re-engineering across the 10 hospitals. and profitability, keeping the service-
of its strategy re-engineering across t
That time, they were faced with business challenges like:
That time, they were faced with busin
MANIP & Drona – EngagingBusiness
Key Talent!
Challenge What did this mean?
Scale up revenue They were at 853.86 crores. Business Challenge What
Improve customer The net promoter’s score, a key organizational health index was at 68– up revenue
Scale They
Prior to 2014, daily operations were
experience plagued by agitations; mostly from the Nursing
with lowest scores on F&B and the Discharge process. department.
Improve customer
For The n
the young nurses, Manipal Control uncertainty in daily Daily operations were being affected by incidents caused due to
was perceived
operations.
as anurses’
quick training ground before they could chase more
experience
agitation, loss of talent, and inability to attract the right type
with l
Control uncertainty in daily Daily
lucrative opportunities. The tenured nurses were found to have become redundant in their
of talent. roles. Mrs.
operations. nurse
Saroja, Chief Nursing Supervisor, recollects “Skills were there, but we were not tapping it. There was of tale
By now, Manipal had realized that to become a differentiated healthcare provider, the internal
a stagnation in our senior nurses.”
customers also need to be aligned towards its vision of Partnership model. A few common people
related challenges cited by leaders were: By now, Manipal had realized that
customers also need to be aligned to
In the year 2014, Manipal introduced a structured induction program called MANIP. related To follow it up
challenges cited by leaders we
with a holistic development opportunity, Highthey also:
attrition in the nursing department owing to better opportunities available
abroad and the emergence of new healthcare operators in India.
High attrition in th
- Introduced the Balanced Score LackCards, defined
of collaboration betweenKRAs, andandincluded
the clinical a parameter of customer
non-clinical workforce. abroad and the emergenc
feedback for nursing care. Challenging to attract good talent for key roles, as hospitals were not perceived as a Lack of collaboration
- Increased communication by creating
preferred employerCustomer Experience Champions across locations.
for growth opportunities.
Challenging to attra
- Trained nurses on Process Compliance parameters. preferred employer for gr
- Launched Drona, a platform which gave senior nurses, paramedics and operations staff a
chance to hone their leadership skills as well as mentor fresh entrants in Pthe nursing division.
age 2|6
This program not only gave tenured nurses an opportunity to showcase leadership skills but
also created subject matter experts. Soon, Dronas started springing up across hospitals, in
Administration, Paramedical and Support Functions too.

Training & Development metrics 2014 2017

Number of Dronas in the system 13 17
Number of programs conducted 26 190
Training man-hours 2300 14600

While man-hours grew by over 6 times, training effectiveness also increased!!

MANYATA - Rewarding not only performance, but also demonstration of values

To drive a high-performance culture, it is important to inspire employees to perform well and

recognize top performers. While faced with challenge of saving lives, every single day, one could very
easily forget to appreciate and recognize smaller efforts that go in!

The trustee-owned Manipal had minimal focus on rewarding employees. While employees felt their
efforts were tied in to a higher sense of purpose, they felt a lack of appreciation from the top
leadership.
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This gave rise to a holistic rewards and recognition platform; Manyata! However, during the initial
years, it did not get the positive perception it set out to meet. In the Great Place To Work, survey, held
in 2014, one of the employee’s shared, “Manyata program has been started in our organization but it
is not given for hard-working or honest people. It is given only for the people who favour managers
and work as they like.”

Another employee added, “Managers are partial; gradings for the employee are not based on the
experience or qualifications. It’s just based on whom the manager likes. Manyata awards are not given
to the people who deserve it.”
The challenge extended to business as well as people. It was centred around how to focus on growth
and profitability, keeping the service-orientation alive. Come 2012, Manipal found itself at theThe
peak
challenge extended to business a
However, Manyata evolved of itsfurther and is across
strategy re-engineering nowthethe most looked forward to award
10 hospitals. among keeping
and profitability, all the service-
employees at Manipal. Popular among allfaced
departments; including of its strategy re-engineering across t
That time, they were with business challenges like: Housekeeping, Security, and support
functions; this program inspires employees
Business Challenge to perform well,
What did this mean? and rewards those who demonstrate That time, theycore
were faced with busin
Scale up revenue They were at 853.86 crores.
values of Manipal. From simple appreciation cards, to annual awards, Manyata became Business a celebration
Challenge What
Improve customer The net promoter’s score, a key organizational health index was at 68– up revenue
Scale They
that employees eagerly lookexperience
forward to. In the most recent
with lowest survey
scores on F&B andheld in 2017,
the Discharge one employee
process. wrote,
Improve customer The n
Control uncertainty in daily Daily operations were being affected by incidents caused due to
“Appreciation is given to the right person. They
operations.
identify the right person’s effort andexperience award them
nurses’ agitation, loss of talent, and inability to attract the right type
with l
Control uncertainty in daily Daily
accordingly. Manyata has made a difference in the organization.”
of talent.
operations. nurse
of tale
By now, Manipal had realized that to become a differentiated healthcare provider, the internal
customers also need to be aligned towards its vision of Partnership model. A few common people
Did the needle move? related challenges cited by leaders were: By now, Manipal had realized that
customers also need to be aligned to
Yes, it did!! related challenges cited by leaders we
High attrition in the nursing department owing to better opportunities available
abroad and the emergence of new healthcare operators in India.
When Great Place to Work® came back to survey employees at Manipal in 2017, 83% of the employees High attrition in th
Lack of collaboration between the clinical and non-clinical workforce. abroad and the emergenc
believed it is overall a great workplace; marking a 22% positive increase from their feedback in 2014.
To ensure Candid Communication, Challenging leadersto attract
started communicating
good talent more
for key roles, as hospitals were notfrequently
perceived as a through
Lack of collaboration
preferred employer for growth opportunities.
Townhalls. To ensure higher involvement of employees in decision making, various initiatives like Ekta, Challenging to attra
People Manager Initiative, LamHE, AGELs and other committees provided a platform topreferred voice employer for gr
suggestions that helped improve business performance as well. To build a positive perception on fair
performance management, goal setting and KRA’s became well-defined and alternate P a g epaths
2 | 6 for career

growth were chalked out for the tenured employees.

This is how the other improvement areas that were identified moved over the years 2014 to 2017:

29%

23%

26%

27%
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Did this have any impact on their business?

While they saw a steady growth in revenues; the customer experience improved significantly.

Business Challenge 2014 2017

Current Revenue (in Cr.) 853.86 1406
Customer Experience 68 84.8

What did employees have to say about the Transformation?

The challenge extended to business as well as people. It was centred around how to focus on growth
and profitability, keeping the service-orientation alive. Come 2012, Manipal found itself at theThe
peak
challenge extended to business a
According to focused groupof itsdiscussions, covering
strategy re-engineering over
across the 50 employees across departments;
10 hospitals. held keeping
and profitability, by the service-
Great Place to Work in October 2017, we find:
That time, they were faced with business challenges like:
of its strategy re-engineering across t

Business Challenge What did this mean?

That time, they were faced with busin
a) Employees perceiveScale
an improvement
up revenue inThey
training and crores.
were at 853.86 development programs offered to them.
Business Challenge What
Improve
This has led to capacity customer
building for The
critical net promoter’s
roles. score, a key organizational health index was at 68–
Scale up revenue They
experience with lowest scores on F&B and the Discharge process.
Improve customer The n
b) A new wave of recognition also incame
Control uncertainty about,
daily Daily which
operations weremade employees
being affected by incidentsfeel appreciated
caused due to
experience and with l
operations. nurses’ agitation, loss of talent, and inability to attract the right type
motivated them to perform better. of talent.
Control uncertainty in daily Daily
operations. nurse
c) Increased transparency and open communication, gives them an opportunity to share of tale
feedback regularly.By now, Manipal had realized that to become a differentiated healthcare provider, the internal
customers also need to be aligned towards its vision of Partnership model. A few common people
d) While scale of operations continues
related challenges to were:
cited by leaders grow, employees are being empowered By now, toManipal
make had realized that
customers also need to be aligned to
decisions and lead initiatives. related challenges cited by leaders we
High attrition in the nursing department owing to better opportunities available
e) Along with this, has come better technology, infrastructure and
abroad and the emergence of new healthcare operators in India.
facilities at the workplace.
High attrition in th
What the future holds… Lack of collaboration between the clinical and non-clinical workforce. abroad and the emergenc

Challenging to attract good talent for key roles, as hospitals were not perceived as a Lack of collaboration
The integration of many cultures preferred
into one Manipal
employer has given birth to many programs that got
for growth opportunities.
institutionalized and are now synonymous with employees who have been part of them. With Values Challenging to attra
preferred employer for gr
at the core of everything they do; The Family Test – ‘do to your patient as you would to your family’
has helped thousands of employees through difficult decisions.
Page 2|6

In the words of Mr. Ganesh Selvaraj, Senior General Manager & Head of Human Resources,
“Importance comes from identity – hence programs are conceptualized and rolled out for employees
to own and run”.

While Manipal continues to face business challenges like bridging the gap between increased costs
and increased pricing, as well as continuous improvement in treatments offered; it will need an equally
strong people strategy to attract the right type of talent and provide excellent career opportunities
that will excite and retain its key talent. Manipal continues to ride the waves of change, learning and
unlearning, but steadily forging its way towards building a high-trust high-performance culture.

References:

http://indiatoday.intoday.in/story/grim-picture-of-doctor-patient-ratio/1/654589.html

(https://health.economictimes.indiatimes.com/news/industry/skill-gap-a-wake-up-call-to-
healthcare-industry/46736989)