Think Beyond, Stay Ahead

“Everything in a hospital needs to scale up, not just the building”

The founder of India’s first corporate hospital recounts how he achieved what he set out to 

In the late ’60s and early ’70s when any engineering or medical sciences student went to the United States for higher studies, it was a one-way street. Returning was never an option, since the overriding thought was to get the Green card and settle down. Only some crazy guys like me came back. I say that because I cannot give you a rational explanation as to why I did. When I was in the US, I wrote regularly to my parents, highlighting not only my achievements but also touching on something that they liked.

As my father was a car fanatic, I used to often send him pictures of new car models. Soon after, when I bought a car for myself, I sent him a picture of the car with my kids in it. His response changed my life. He wrote back saying, “We are happy with your achievement, but if  you could do the same thing back home, a lot more people would be happy.” My wife and I felt that would be the right thing to do and we decided to return for good. Fortunately for us, our children had not yet reached an age where they could protest our leaving the ‘land of plenty’.  

Starting over

Most of my colleagues felt it was a foolish decision. Not that I had any second thoughts, but it was not easy setting up a local practice in Madras. It had none of the luxury or facilities I had gotten used to. I may have been trained in advanced cardiology but there was no enabling infrastructure, be it a basic treadmill, an ECG device or ICU equipment. Even after I got a decent set-up going, only a few benefited. While those who came to us did get the best possible care and monitoring, we were not geared up for dealing with critical conditions that needed surgery.

That is why I used to send some of my patients from HM hospital to the US to consult with Dr Denton Cooley, a friend who in more than one way helped build my vision. It was during those early days that a young man died because he could not raise the $50,000 needed to go to the US to have the surgery. His loss of life caused me a lot of hurt and anguish. The principal thought at that point was, “How many more people are going to lose their families this way and why should they? If things can be done in the US by Indians then why can’t they be done here?” 

The solution as it struck me was to start providing the best level of affordable care. When I discussed this thought with a few close friends, they thought I had gone cuckoo. A couple of them said, “Because you have built up this big practice in a short time, it has gone to your head.” To their scepticism, my retort was, “What has got into my head is the failure that I have seen, as well as the helplessness of people I can’t reach out to.” Given the discouragement here, I went to the US to talk to some of my former colleagues, for by then all of them had become senior physicians. Also on my agenda was a visit to Nashville, Tennessee, the birthplace of the first corporate hospital in the world.

Dr Thomas Frist Junior was responsible for founding HCA — Hospital Corporation of America. Despite being an exploratory visit, Frist Junior was gracious enough to invite me for lunch. Over lunch, he said, “Let me tell you our story. We started HCA because we felt that the care that people got in the charitable and government hospitals was not of the highest quality and also not priced right. That is why we bought in systems and corporatised healthcare.” To his surprise, I jumped up and said, “That is exactly what I have in mind.” 

Never say die

Upon my return, there were a whole lot of obstacles waiting to welcome me. I was told that a hospital could not be a corporate entity, and for the land that we bought, we received a handwritten note from the then chief minister of Tamil Nadu MG Ramachandran, stating, “Stop all construction activity of Apollo Hotels.” To begin with it was a hospital, not a hotel, and so I demanded an explanation. After a month we were informed that we did not have urban land clearance. As far as I was aware nobody had asked for urban land clearance for a hospital before. 

So I was stuck and it took me a year and half to get that cleared, which in itself is quite a story. As I was playing for keeps, through a few acquaintances, I decided to take my case to the then prime minister, Indira Gandhi. After I was ushered into her office, I told her, “Since vital medical equipment is taxed at 340%, only two kinds of people can get good healthcare in our country — the powerful and the rich. The powerful guy flies free via Air India and the embassy bears his expenses. For the rich guy it does not matter what it costs.”

As for the local land issue in Madras, since she was not on great terms with MGR, Gandhi suggested, “Why don’t you set it up in a Congress-ruled state like Andhra Pradesh or Karnataka?” (That is how our Hyderabad facility happened. When we started work on Apollo Health City at Jubilee Hills, there was no habitation there. Of course, now it is the centrepiece of the most precious part of Hyderabad.)  

Since the Madras status quo was yet to be resolved, I persisted with Gandhi that all I was asking for was a permission that would be given to any other industry. At her behest, the principal cabinet secretary wrote a very strong letter to the MGR government demanding an explanation as to why work at the Madras hospital had been asked to be stopped. Until that point, MGR had avoided meeting me on every occasion. Post the letter, his men went looking for me all over Madras. When we met, he said, “If there is something between us, you should not go to the prime minister. We should sort it out.” He then gave his clearance. That was not the end of my problems though. I still had bureaucratic red tape, funding and staffing issues to resolve. 

To get doctors for the new hospital and to motivate them was also a very big challenge. I got some of them to come back from Canada and the UK. But they had to meld together. I told them, “You have come from different places and different communities, but under this roof, our religion is to produce the same results as the best institute in the world.” This philosophy was communicated all through the hospital and I don’t think we ever looked back.

I continued to get help along the way, both from outside as well as from my own family. My daughters have played a very key role in building the group, even though none of them are qualified doctors. Even the name Apollo, symbolising the Greek god of healing, was chosen by my second daughter Suneeta. I recall going to the astrologer to check if the name “Apollo Hospital Enterprise Limited” was auspicious. While he expressed disapproval at first, he just added an extra S and exclaimed “Apollo Hospitals Enterprise Limited is great”. In my mind, I went, “Great! Here I am struggling for one hospital, and this fellow is already planning hospitals.” 

Touchstone

When we started out, everything had its advantages and disadvantages. Advantage because the canvas was fresh and large and disadvantage because there was no precedent. My logo is a nurse, and that is because that is the only person who is continuously connected with a patient. The greatest decision that we took was bringing in the WE concept. I was clear right from the beginning that we cannot have islands of excellence, which is why the WE form of functioning is ingrained in the group’s philosophy.

A great surgeon needs a great post-operative team, that, in turn, needs good ward care, nourishing food, extremely competent housekeeping, diligent security and great billing and discharge systems. If you ask my maintenance guy now “What happens if your water boiler doesn’t work?”, he won’t say there won’t be hot water. He will say the hospital will come to a standstill. The reason is sterlisation won’t happen and that is a hygiene factor for a hospital. Like that everyone knows they have a role to play. 

We monitor all this through what is termed in-house as Apollo Clinical Excellence parameters. Since you cannot be physically present everywhere, we have an MIS called Lighthouse, in place for more than 10 years now, for the top management to know what it needs to know. It includes theatre parameters, revenue parameters, budget variations etc. So at the touch of a button I can find out where we stand. Everything that we track is colour-coded and benchmarked. If it is blue then it is very good. Green if it is good, then come pink and red. When it comes to pink and red, my secretary automatically knows that a review is in order. 

We have also desisted from mindless expansion. There was a time when we struggled to raise ₹10 crore, now bankers land up at my office wanting to give me 500 crore. Day in and out we have interested parties coming to us and saying, “Let us put up 100 hospitals, everything can be arranged, we just need the Apollo stamp on it.” Not that we have not thought of it, but there is a good reason why we aim for 2,000 beds every two years. We are not thinking 5,000 or 15,000 because we need to scale up everything in the hospital. It is not just about the building or equipment that makes a hospital. I need the right kind of doctors and managers. While raising capital is not an issue today, we still find it difficult to raise the talent required. 

We have partly addressed this issue through health education and e-learning programs, but have not been able to cope up. Buying existing beds instead of creating them also does not address the country’s overall demand-supply gap. On the contrary now, we are not encouraging managed hospitals unless it is totally overseen by us under a long-term, 15- to 30-year contract. We had a few bad experiences in Dubai and Colombo where the focus changed more to making money than delivering the Apollo level of care. So, we had instances of non-paying departments being shut down and holistic healthcare being given lip service. Having learnt the lesson once, we can’t repeat the same mistake.

Today, we have treated the numbers and got the desired outcomes. We have done over 125,000 coronary bypass surgeries and have now overtaken the best hospitals in the world. We have also become the world’s number one hospital for organ transplants this year. I don’t know if any other hospital group outside the US has seven Joint Commission International accredited hospitals, has treated 26 million people or done 6.5 million preventive checkups. We have now moved to doing robotic surgeries that ensure greater precision for our patients. I am proud of the fact that during the last 28 years our pharmacies have not sold even one spurious drug, in a country where 30% of the medicines sold are spurious. That is why people buy from our pharmacies — they know the drugs are reliable and so are the prices. 

Apollo was also the first medical institution in the world to use satellite technology for telemedicine. I have no doubt that India will transform healthcare delivery using information technology in an immense way. When there is a challenge, it means there is also an opportunity. The challenge in India is unmet healthcare needs. Apollo started because I couldn’t send my patients overseas for treatment. That is now no longer required. The world is coming to us. 

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