IIM BANGALORE

MPPO PROJECT INTERIM REPORT

Group # 3 Section B
Submitted by: Avinash Kumar (1111157) Abhik Saha (1111082) Chhedup Lama (1111097) Kanika Bharti (1111112) Nitin Dua (1111127) Sashank Rao (1111142)

Introduction We have studied healthcare as our industry to evaluate the factors for job performance. And we have briefed three hypotheses which has potential impact of Job performance based on the interviews conducted (Annexure 1). Questionnaire for the Interview Tell us more about your profession and about your practice? How long have you been into the profession? Why did you choose this profession? What do you like about this profession? What are the factors that motivate to perform your job well? Have you ever faced any challenges or have there been times when you suffered from de-motivation? What are the three most important values that guide your thoughts and actions as a doctor? How much does the context in which you are operating affect your performance? For instance, had your performance been different were you operating in a different location or in a different set-up? When you think about times that you have performed well, what factors contributed to that performance (please list both extrinsic and extrinsic)? Is a doctors performance hindered by not being able to strike an emotional chord with the patient? What about technology and its impact on performing well as a doctor? (Improving efficiency vs. the actual treatment) Participants for interview: Dr. Sekhar Mondal (Experience 30 yrs) Doctor Specification: General Practice and Chest Nature: Private Clinic Address: Vill : Palpara, PO- Dhulasimla, Dist:Howrah, West Bengal 711315. Phone: 09830011019

Email: 0sekharmondal@gmail.com Dr. Jyotirmoy Saha (Experience-27+yrs) Doctor Specification: General Practice Nature: Private Clinic Address: Rafi Ahmed Kidwai Street, Kolkata Phone: 09830011019 Email: drjsaha@yahoo.com

Dr. Sanjay Gururaj (Experience 10yrs) Doctor Specification: General Physician (plus Pediatrician and Neonatologist) Nature: Private Clinic & Medical Director at a Private Hospital Address: #307, 40th Cross, Jayanagar 8th Block, Bangalore 560 082 Phone: +91-98452 33040 Email: sanjay@shrc.asia Dr. Neetika Rana (Experience 1 yr) Doctor Specification: General Practice as dental surgeon Nature: Private Clinic Address: Dr. Ghumbar Clinic, Sector 3B-II, Mohali Phone: 7508029778 Email: drneetika.rana@yahoo.com Dr. Dinesh Doval (Experience 30+yrs) Doctor Specification: Medical Oncology Nature: Private clinic/ Hospital owner/Part of a big private hospital/Govt. hospital, Address: Rajiv Gandhi Cancer Inst Sec 5 Rohini, Delhi 110085 Phone: 91-11-47022428 Email: dcdoval@gmail.com
Predictors for good job Performance: Motivation to alleviate human pain Social Recognition Challenges in the profession

Exhibit 1: Predictors of Job performance in healthcare

Hypothesis H1: There is a significant positive correlation between recognition received and job performance. Medical Sciences have been the most prized and respected profession from time immemorial with its stand on a Godly life-saving pedestal. Most of the respondents have revealed that the respect they get from their patients and their families has a very strong influence on their job performance. The respect they draw through their lifetime is a factor that drives them beyond all boundaries.

H2:

Motivation to alleviate human pain is positively related to on Job performance.

In one of our surveys the following were answered: 1. Do No Harm. Even if you cannot heal. 2. Be considerate to the lesser privileged. 3. Money is not the sole consideration in providing medical service. Every point reveals an embedded message of the social respect and social upliftment instilled in him. In one of the other surveys, a lifesaving incident that prompted an elderly person to touch the doctors feet stands tall an incident to motivate her higher towards humanity and better performances in future.

H3: Challenges in the profession plays a major role in doctors performing their job well Our surveys revealed motivation out of the challenges faced. Everyday offers ambiguity and challenge. Everyday offers variety in the cases of patients met. It demands sound knowledge and every case dealt adds experience and confidence, while a negative case though still instilling fear, still strives them to move forward and get stronger.

Annexure:

Dr. Sekhar Mondal (Experience 30 yrs)

Q1. Tell us more about your profession and about your practice?
In 1981 I came to this profession in my native village Palpara. My basic work is to treat patients carefully and provide a guideline for cure.

Q2. How long have you been into the profession? Why did you choose this profession?
Around 30 yrs. I choose this profession to treat my village people.

Q3. What do you like about this profession? What are the factors that motivate to perform your job well? Please list around 3-4 factors and rate them in order of importance.
I can cure the pain you have. I) When a patient greets me after cure. ii) Everyday my experience and knowledge is increased. iii) Respect of the people iv) Money comes automatically; there is no need to run after money. v) Meet different people and their different cultures.

Q4. Have you ever faced any challenges or have there been times when you suffered from demotivation?
In one or two situation where patient died due to delay of some testing and lack of good infrastructure.

Q5. What are the three most important values that guide your thoughts and actions as a doctor?
i) treat every person irrespective of his/her economic condition. ii) Listen to every single word. iiI) I have to respect my patients

Q6. How much does the context in which you are operating affect your performance? For instance, had your performance been different were you operating in a different location or in a different set-up?
In my area there is no sign of modern treatment facilities, so when a patient condition is critical there is no other way to refer him/her for Kolkata. Another thing will come to consideration is the social and economic condition of this area is very poor. So in other area, with other social and economic condition, with better technology, I think my performance will increase. But in this situation, I have to optimize my work.

Q7. When you think about times that you have performed well, what factors contributed to that performance (please list both intrinsic and extrinsic)?
Thoroughly clinical examination and proper history taking.

Q8. Is a doctors performance hindered by not being able to strike an emotional chord with the patient? What about technology and its impact on performing well as a doctor? (Improving efficiency vs. the actual treatment)
With more than quarter century of practice, my patients become my relatives. It is true that a doctor performance will hindered by not being able to strike an emotional chord. There are so many recent machines avail in the market by which some basic examination to a patient is now easier and time efficient.

Contact Details
Doctor Specification: General Practice and Chest Nature: Private Clinic Address: Vill : Palpara, PO- Dhulasimla, Dist:Howrah, West Bengal 711315. Phone: 09830011019 Email: 0sekharmondal@gmail.com

Dr. Jyotirmoy Saha (Experience27+yrs)

Q1. Tell us more about your profession and about your practice?
It is very challenging. Peoples expectations are very high. This is not a pure science and every individual has his/her constitution of various factors involving genetic as well as environmental. To add to this is economic factor. Those who can afford treatment expect miracles and those who can't want to be well in days as a day lost is a wage lost. I am a Family Physician a rare breed now a days! Being an urban doctor my practice revolves around families as well a shifting population of low wage earners working in business districts of the city of Kolkata. The problems or cases that I face may be quite different from the rural practitioners.

Q2. How long have you been into the profession? Why did you choose this profession?
I am in this profession for more than 27 years. There are quite a few reasons for choosing this profession. When I was young in school I used to suffer a lot from various ailments and often missed school or had restrictions in my activities. These ailments took me to the doctors of multiple specialties and I was exposed to their ways of working and I was fascinated. I thought if I become a doctor in future I may be in a better position to help people and myself. Doctors earned tremendous respect and that also motivated me to become a doctor. I had a natural flare and liking for Biology, dissections and exploration of life forms.

Q3. What do you like about this profession? What are the factors that motivate to perform your job well? Please list around 3-4 factors and rate them in order of importance.
Facing new challenges every day, as each patient needs individual care. Difficult cases treated in consultation with Specialist/ Consultants when cured or relief given gives immense satisfaction. One thing I have always followed is "Do no harm". I treat patients as much as I know and the moment I realize that the case is beyond my knowledge I refer the case to a Senior/ Consultant so that no time is wasted and harm done to the patient. Success and failures both motivate me. Newer approaches from updated knowledge help to improve and serve better. Constant updation of knowledge by attending Continuing Medical Education programs, Conferences etc gives tremendous motivation to try new treatment regimes.

Q4. Have you ever faced any challenges or have there been times when you suffered from demotivation?
Yes I have faced many challenges. But I have not suffered from any demotivation as I am tremendously positive in my thinking. I always say and believe that every day is a new day. You do not know what is waiting for you, and unless you think positively you cannot enjoy or receive the good that is waiting for you.

Q5. What are the three most important values that guide your thoughts and actions as a doctor? 1. Do No Harm even if you cannot heal. 2. Be considerate to the lesser privileged. 3. Money is not the sole consideration in providing medical service.

Q6. How much does the context in which you are operating affect your performance? For instance, had your performance been different were you operating in a different location or in a different set-up?
I don't think so. We all have to adapt to our environment and not crib about what is missing. We should to try to improve our surrounding and move along.

Q7. When you think about times that you have performed well, what factors contributed to that performance (please list both intrinsic and extrinsic)? 1. An honest attempt exploring maximum possibilities 2. Patients ability to co-operate, medically and financially Q8. Is a doctors performance hindered by not being able to strike an emotional chord with the patient? What about technology and its impact on performing well as a doctor? (Improving efficiency vs. the actual treatment)
I think emotion is required to some extent as we are all humans treating humans. Compassion is required to realize suffering and that will motivate to bring faster relief. Regarding technology- it has to be accepted. Previously, treatment was basically on clinical symptoms but that took time to develop. Nowadays we can diagnose disease much earlier with many sophisticated diagnostic tests thereby providing early and often prolonged relief or cure. Of course the question of affordability comes- but it should be offered to those who can.

Contact Details
Doctor Specification: General Practice Nature: Private Clinic Address: Rafi Ahmed Kidwai Street, Kolkata Phone: 09830011019 Email: drjsaha@yahoo.com

Dr. Sanjay Gururaj (Experience 10yrs)

Q1. Tell us more about your profession and about your practice?
Basically I am a Pediatrician and a trained Neonatologist, but of course, I have also picked up bit of my fathers and my grandfathers practice because of the strong family history of being well-known doctors here in Bangalore but basically into Pediatrics and Neonatologist. I had my basic training in India, and subsequently studied in the UK (for my specialization)

Q2. A) How long have you been into the profession? Why did you choose this profession?
I came back from the UK in 2003 so all in all I have been in practice for nearly 10 years now.

Q2. B) Why did you choose this profession?

Oh, my decision to take medicine was almost completely because of my family background! My own personal goal was to play in a rock band! Why, we even had a band back in junior college where I was the lead singer and everything. But then my dad said that Listen, there is no point being second best at something. So its best you just do your medicine But then, to be fair I have also had a flair for general medicine, obviously because many in my family are all doctors. I had a natural drift towards medicine. Its not wrong to say that it runs in my blood because when you hear about it every day from morning to night, studying medicine became an automatic decision. Though off the record I would still love to be playing for a band!

Q3. A) What do you like about this profession? How did your interest come about?
See, when we started it was just another professional college. So you just went through the course for four and a half years. There is no great passion then. Your next target is just passing your next exam and doing well there. However, in the mean time, what I realized very fast is that to specialize in any field, be it surgery or obstetrics, your basics need to be very strong, which was also something I learned from my dad. Take Denton Cooley, who is this very famous heart surgeon. But if you ask him to do an anal abscess he would still do a perfect job, even though he is a cardiac surgeon per se; simply because his basics are very sound. So the focus then became to develop my basic skills. Also, the pass rate in medicine is very low (nearly 15% only) so its mostly slogging and no passion at the start. However, down the line I developed my inclination for general medicine, cardiology, and then pediatrics.

Q3. B) What are the factors that motivate to perform your job well? Please list around 3-4 factors and rate them in order of importance.

For me its very clearly the ability to make somebody feel better. All factors eventually lead to that. You have the domain, the knowledge (after extensive study) and the ability then to actually change someones life by giving them relief. It can happen in a day, a week, or a month, but what drives me is the passion and ability to help somebody out of their difficulties. Actually, as much of clich as it is, I really do feel that. Thankfully, I havent ever woken up in the morning with the dread of going to work (although I might jokingly complain about how much of work there is!) The second factor is that its extremely interesting. It isnt like the same old mundane work. Every patient is unique so there isnt such a thing as a standard operating procedure to do the same thing. It makes me use my head and keeps challenging me which is great. Thirdly, and in a lighter vein, in India doctors are looked upon almost as demigods! But seriously, the adulation also helps. Because for me the profession isnt very money driven, the fact that patients look upto you is something that is very gratifying. This is obviously coupled with the first factor of having the ability to help. So even though initially I thought this was all a clich and that the whole point of the profession (as with any profession) is to make money, it is no longer that and I believe that this passion will be my driving factor in the future also.

Q3. C) So does this belief result from the background that you have, or do you believe that it is the typical outlook any doctor might have?
Actually no, this would not be normal for pretty much anybody. There are a lot of cases where doctors digress from what they are actually trained to do because they find things can be monotonous at times. Definitely my background does not allow me to deviate too much and helps me stay focused. So on an average I would expect that on an average 70% of doctors should also echo my sentiments. But then I have also been blessed with the fact that my background has helped me get more patients and I have had good exposure in the private practice with ample opportunity to prove myself. A lot of people do not get that chance; they literally have to go to the jungle and fight it out. So the background has definitely helped. Also, seeing my dad who is 75 and yet enthusiastic to see patients, obviously keeps me motivated too.

Q4. Have you ever faced any challenges or have there been times when you suffered from demotivation?
Actually the point is for me I am very clear about this. I cant keep working with the same passion and same pace throughout. So I have my own mechanisms to de-

stress myself and this is not just stress management. For example, currently my biggest stress reliever is being with my daughter. Also I take breaks very often. In fact I must be about the only doctor in Bangalore who takes breaks every two months, travelling etc. And that does help me unwind and come back fresher and remain motivated. Any job has an element of monotony that sets in, not necessarily careless, but monotonous. It shouldnt impact your ability to work, so even if I am called at 3 in the morning to attend a delivery I am able to keep myself fresh and then start another day fresh right after. That is how I am made I suppose, and a lot of other doctors are.

Q5. A) How much does the context in which you are operating affect your performance? For instance, had your performance been different were you operating in a different location or in a different set-up?
So for me there are two things here. There is a large commerce aspect to any profession you do. So in that aspect I have been lucky that my other practice (at Shanti nursing home) we are able to do substantial amount of charity as well. We have a trust that actually gives healthcare to people who are underprivileged and do not have the money. To be honest, I am not trying to play Robin Hood. Its not about taking from the rich and giving to the poor. You land up taking from all, but there is a substantial amount of relief and happiness when you treat someone who is underprivileged, because you know that in ordinary circumstances that person would not have been able to afford the treatment. But thanks to the trust we have, this added satisfaction is possible with no commercial interests involved. Now, my approach to patients does not change. Either if a taxi driver or N S Raghavan brings his kid to me for treatment, my approach pretty much remains the same. When somebody is sick they are sick, no tags are attached. Working in a place like SHRC, which is this upscale boutique hospital or another nursing home doesnt make much of a difference. The care remains the same.

Q6. A) Do organizational expectations make a difference? Contrasting them with a private practice where you are in greater control? How does that affect you at work?
Well yes, but luckily in this organization I am the one who is drawing those lines! But yes, there is always the pressure. Like the people at SHRC expect me to spend more time here, expect me to do more work, so there are limitations for me, because I am now running two organizations. So there is some amount of pressure but it does not impact your healthcare. I am now expected to spend more time in the hospital and do things like business

development, which are new things for me. Life as a doctor used to be only seeing patients, but now I am expected to decide how to scale business etc. so the face of healthcare has undergone a big change for me. But that doesnt impact my healthcare much, and as I said the organization does not pressure me too much, simply because we make the rules!

Q6. B) Right, but then looking at other hospital chains like Apollo or Fortis, is organizational pressure something you have observed there?
In other hospitals the problem is that it becomes a complete number game. You are expected to achieve your numbers. Its like working in an investment bank almost. And for investors who have put in so much money into these hospitals, their primary concern, and to be fair to them, is that. They are very sure about the healthcare they can impart, their infrastructure etc. so then it becomes a matter of numbers you can achieve with worries about depreciating machinery, becoming cash positive etc. They then put pressure on consulting doctors, and that can fluster them. Many people cannot take that pressure, and may be forced to be unethical in performing treatments when not required, simply to achieve numbers. And there is always the added incentive for achieving those numbers.

Q7. When you think about times that you have performed well, what factors contributed to that performance (please list both intrinsic and extrinsic)?
Basically I find the logical approach to problems is the most important thing. You cant bring any personal difficulties at home, to work and take it out on your patients. So having that sense of dissociation from personal life to professional is what makes the biggest difference and is the biggest mantra. You will never have that beautiful day at home, it doesnt work. So you need to find your method of dissociating that from work. And then the logical approach to problem is the most important factor. Sometimes there might not be apparent solutions, and so then you do the second best. You cant always have the perfect solution, and it is also important to accept that. Also, how we are trained in medicine is that it is largely evidence based treatment. Its not like I get a flashy idea that I then implement on a patient. Its very evidence based; if you see A, B and C symptoms, you treat it this way or otherwise. So if you are able to put logic into a problem you typically do well. Plus there is also experience. Another important factor has been keeping myself updated. In our field, technologies change, instrumentations change, methods change, and so you need to keep yourself updated. India suffers from not having certification credits for doctors because if you do that you are on par with others in the world and are able to offer the best to your patient.

Q7. Can you elaborate on the point about credits?

Ok, so in the US if you are a practicing physician, you have to have credits, write exams every three years, update your knowledge and get extra credits for the facts that you know. In India there is no such system yet, whereby you can prove that you have attended training programmes studied about it and improved your skills. This does let the patient know that you are well updated about your field and are well equipped. Instead now, you are forced to see my face and take what I say at face value. So this system and the logical base are what help me do well, and come out of any problems I have faced. The only things that can affect you are having a disturbed personal life or being very pre-occupied. That is why the dissociation from personal to work becomes all the more important.

Q8. A) Is a doctors performance hindered by not being able to strike an emotional chord with the patient? What about technology and its impact on performing well as a doctor? (Improving efficiency vs. the actual treatment)
Yes it is. When it comes to healthcare the person has to trust you. So in the end whatever qualification you have just adds up to that trust. It is that personal interaction that matters. I think it is extremely important to strike a chord with the patient. The patient must feel that the doctor is thinking for me and hence will trust you to take the right decision. That is extremely important. Of course knowledge is important but it is the approach to the patient that almost always defines your practice. You have to be very compassionate. Even people who arent that qualified but who are great talkers are actually able to develop a very successful practice.

Q8. B) Is this almost like a placebo effect, where actual medical treatment is not even required?
Exactly. Sometimes just talking to someone else gives enough comfort and reassurance that the doctor is speaking the truth. That can be a huge help in situations.

Q8. C) Is this something that is addressed in a doctors education or is it an innate skill?

No its not. This is a very individualized attribute. There is no actual chapter on handling human relationships. It is a very personal thing. But also what happens is in places like Bangalore and big cities you are naturally forced to

be nicely spoken. Take for example, any hotel where you can turn up at any time of the day and still be politely greeted. Similarly, we are also trained, especially if you are trained abroad, to talk the right way to the patient, dress correctly, wear the right clothes, etc. All these intangible aspects are addressed there, and differentiate you from another person, and also add up to instilling trust in the patient towards you. No question about it.

Q8. D) So Sanjay, in the end if I was to ask you to define one factor among all that we have discussed, that defines a doctors performance; something without which he/she will struggle to perform, what would that be?
I think it has to be a logical approach to problem solving. That is the key. You cant just sweet-talk a person and treat him. You have to have the passion, knowledge, the bandwidth to remain updated, know what you are talking about, but in the end it is the logic that you use to solve the problem that matters most. Also, experience does count, because everything isnt straightforward logic at all times. So experience does help, but still it is the logical approach that matters most, in almost any context. It might even sometimes appear to be mechanical, but that is ok. In healthcare you dont have the option of reversing your treatment. You have to have the right approach the first time, and so having a logical approach is the most important aspect for a doctor.

Contact Details
Doctor Specification: General Physician (plus Pediatrician and Neonatologist) Nature: Private Clinic & Medical Director at a Private Hospital Address: #307, 40th Cross, Jayanagar 8th Block, Bangalore 560 082 Phone: +91-98452 33040
Email: sanjay@shrc.asia

Dr. Neetika Rana (Experience 1 yr)

Q1. Tell us more about your profession and about your practice?
I am a dentist. I have been in practice since last one year. It has been a very learning experience and I could put into practice what all I learnt during my course of graduation.

Q2. How long have you been into the profession? Why did you choose this profession?
I have been in this profession since last one year. I wanted to give my services to society and since it is a very noble profession so I thought I could serve people better by relieving them from pain. Moreover, its a rewarding profession and you can earn as well.

Q3. What do you like about this profession? What are the factors that motivate to perform your job well? Please list around 3-4 factors and rate them in order of importance.
A smile on a patients face after he/she being cured is the biggest reward for a doctor, which makes you feel satisfied and happy at the end of the day that you had done justice with your work and your patient. The factors that help you perform your job well are good hand work, hard work, positive attitude, self-confidence, patients confidence in your work and the sense of responsibility towards your patient.

Q4. Have you ever faced any challenges or have there been times when you suffered from demotivation?
Yes,when you get stuck with some case and you feel that you can't handle in any more and you feel that you need an extra hand for help,when it should have been done by you alone.

Q5. What are the three most important values that guide your thoughts and actions as a doctor?
That your patient trust you with his life, so you should be responsible, and respect that...doctor's are still thought to be as God by the patient, so he should give his 100% help for curing a patient.

Q6. How much does the context in which you are operating affect your performance? For instance, had your performance been different were you operating in a different location or in a different set-up?
Yes it does matter on situations...like you need to be different when you are in a clinic and when you are on some medical camp, and the situation is very different when you are handling an emergency.. The pressure and performance does differ with situation.

Q7. When you think about times that you have performed well, what factors contributed to that performance (please list both intrinsic and extrinsic)?
Patients satisfaction, patients confidence on you, your hard work, your skills and intelligence, experience.

Q8. Is a doctors performance hindered by not being able to strike an emotional chord with the patient? What about technology and its impact on performing well as a doctor? (Improving efficiency vs. the actual treatment)
Being emotionally attached to a patient makes you weak.

Contact Details
Doctor Specification: General Practice as dental surgeon Nature: Private Clinic Address: Dr. Ghumbar Clinic, Sector 3B-II, Mohali Phone: 7508029778 Email: drneetika.rana@yahoo.com

Dr. Dinesh Doval (Experience 30+yrs)

Q1. Tell us more about your profession and about your practice?
Iam a practicing medical oncologist and am in a private cancer institute which is also an academic centre.

Q2. How long have you been into the profession? Why did you choose this profession?
I have been in the profession for more than 30yrs. It was considered to be a noble profession at that time and i had inclination for it.

Q3. What do you like about this profession? What are the factors that motivate to perform your job well? Please list around 3-4 factors and rate them in order of importance.

Most important factor is to see smile on the face of a patient given death sentence, Most important factor is patient and self-satisfaction, being recognized and keeping in touch with the latest developments.

Q4. Have you ever faced any challenges or have there been times when you suffered from demotivation? Hard work dedication and smiling face of off treatment follow up cured patient after many years. Q5. How much does the context in which you are operating affect your performance? For instance, had your performance been different were you operating in a different location or in a different set-up? I am doing quite fine in my ambience only thing i wish is I had more time to devote to each patient and the patients are more disciplined and educated about their disease. Keep their appointed time and be cool in the OPD. Q6. Have you ever faced any challenges or have there been times when you suffered from demotivation? Treatment failure in a curable case. Unexpected deaths. Q5. What are the three most important values that guide your thoughts and actions as a doctor? Being a good human being, compassion, hard work, will to help others. Q6. Is a doctors performance hindered by not being able to strike an emotional chord with the patient? What about technology and its impact on performing well as a doctor? (Improving efficiency vs. the actual treatment). A doctors efficiency is definitely hindered if there is no establishment of the emotional chord with the patient. Technology definitely helps but cannot replace the human touch. The treatment should not become high tech and low touch.

Contact Details
Doctor Specification: Medical Oncology Nature: Private clinic/ Hospital owner/Part of a big private hospital/Govt. hospital, Address: Rajiv Gandhi Cancer Inst Sec 5 Rohini, Delhi 110085 Phone: 91-11-47022428 Email: dcdoval@gmail.com