Friday, April 26, 2019

Think about your patient first



First thought this morning
Voting for the election of 17th Lok Sabha is complete in more than 300 (of 543) seats. Voters in more than 20 states have exercised their franchise. From the voting pattern so far and anecdotal evidence collected by me, the following four trends are noteworthy:
(a)   The overall voting percentage this time is similar to 2014, however there are significant differences at regional level.
In 2014 elections the voter participation was amongst the highest since independence. Analysts attributed the high voting percentage to the Modi wave and peoples' longing for change. This time apparently there is no wave, or material anti incumbency for that matter. The still high voter participation therefore is bewildering for both analysts and political parties. Everyone is therefore trying to see it from their own prism. The incumbent and their supporter are seeing this as a vote for stability, while the others are terming it as a vote for change. Higher number of first time voters who are not as droopy as their elders could be another reason for higher participation rate.
(b)   Usually wherever a stronger regional party is present, Congress is not doing well. Haryana though could be an exception. The general feeling is that the contest this time is primarily between BJP and Congress, and the regional party INLD (and its factions) is in total disarray. RLD in Bihar has held together well under the same circumstances (patriarch in jail).
(c)    The campaign so far appears as if we are voting in a referendum on the Prime Minister and not in a general election for Lok Sabha.
(d)   Given the penetration level of electronic, digital and social media, the ban on campaigning upto 48 hrs prior to voting, has become totally redundant.
Chart of the day
Think about your patient first
Once a patient was admitted to an upscale private hospital (XYZ) with a serious cardiovascular ailment. The cardiology team at the hospital was headed by an experienced old surgeon, who was lately rendered incapable of performing complicated surgeries due to his blurred vision and trembling hands.
The team he headed was however not harmonious. Many doctors were either incompetent or had allegiance to their vested pecuniary interests. They would often indulge in unethical practices and conduct unbecoming of a reputable medical practitioner.
The management of the hospital was fully aware of the state of affairs at the hospital, but did little to put the house in order. The popular belief is that the management itself encouraged the disharmony amongst the team members and incongruence of the objectives to stay in control of the institution and maximize the profitability.
The head of the team diagnosed the patient's condition accurately and proposed a line of treatment, which would treat the patient promptly with minimum pain and cost. The team members however disagreed. They wanted the patient to spend more time in hospital and undertake a variety of experimental tests and procedures. This would cost the patient much more and cause more pain. The management concurred with the unethical lot of doctors.
After spending some time in the hospital, paying huge costs, and suffering tremendous pain, when the relatives of the patient saw condition of the patient worsening, they moved him to another hospital (PQR).
The doctors at PQR studied the case history and discovered that the patient's condition was accurately diagnosed at XYZ and correct line of treatment was proposed by the head of the department. The doctors there decided that once the condition of the patient is stabilized they would follow the same line of treatment as suggested by the old surgeon at XYZ.
In few days, the condition of the patient stabilized and he was moved out of the intensive care to normal ward. The doctors at PQR hospital then started the treatment as suggested by the head of the department at XYZ.
However, considering the slow recovery and frequent relapse, the head of the department at the PQR decided to try some unconventional treatment. The patient did not respond to these unconventional methods and his condition worsened materially.
He was again moved to intensive care. The doctors then followed the line of treatment prescribed at XYZ. The patient stabilized and his vital signs showed some improvement. But the patient is far from being cured and remains hospitalized, suffering pain and expenses.
The relatives of the patient are now in a quandary.
Fully aware that doctors at XYZ correctly diagnosed the disease and advised the right line of treatment, they still do not want to reconsider XYZ for its lack of ethics and unfair practices.
They are not too pleased with PQR either, as the unconventional experiments done by doctors there cost them significant amount of money besides inflicted tremendous pain to the patient. But they are willing to forgive PQR since it is now following the same line of treatment which XYZ would have followed.
There is a third hospital (LMN), but it is new, untried, untested and lacks adequate infrastructure. The doctors there have good track record of minor surgeries and treating minor ailments. But trusting them with a serious case and major surgery could be a big risk.
In the meanwhile—
(a)   Doctors and management of XYZ are accusing the management and doctors at PQR of unethical practice and incompetence, charging them with appropriating their diagnosis and following the same line of treatment as they had suggested.
(b)   Doctors and Management at PQR are trying hard to convince the relatives of the patient that if they consider shifting from their hospital, the life of the patient could be at serious risk.
(c)    The doctors and management of LMN are trying to lure the relatives of the patient with a promise that they would engage the good doctors from XYZ and continue with the same treatment at somewhat lesser cost.
PS:
If it is not clear enough, I may disclose identity of the characters in this story:
The patient - Indian economy
Relatives - Indian voters
XYZ - Dr. Manmohan Singh and Sonia Gandhi managed UPA
PQR - Narendra Modi led and managed NDA
LMN - The coalition of regional parties

Thursday, April 25, 2019

Managing change - a political perspective - 3

Some food for thought
"Revelation can be more perilous than Revolution."
—Vladimir Nabokov (American Novelist, 1899-1977)
Word for the day
Bardolatry (n)
Great or excessive adoration of or reverence for William Shakespeare
 
First thought this morning
The incumbent government is inducting 9 professionals into civil service at joint secretary level. Though the issue of lateral entry of professional with domain expertise in civil services was being debated for many decades, it appears to have been now settled. If successful, this will go down in history of independent India as a watershed reform.
I am not privy to the criteria, if any, that will be used by successive governments for appointment of professional directly at higher levels in administrative hierarchy, but I would like to see, inter alia, the following safeguard being taken:
(a)   There should be a objective qualification criteria for lateral entry of professionals in civil services. The selection and appointments should be made by UPSC without any political interference and pressure.
(b)   Adequate safeguard should be applied to make sure that the process does not degenerate into discretionary political appointments like political advisors/secretaries and OSDs by ministers.
(c)    The tenure of the lateral appointees must be fixed and posting limited to the departments falling within their domain of expertise.
(d)   The Chief Secretary must be made accountable for their induction and cooperation by the legacy civil servants. Former UIDAI chief Nandan Nilekani's experience in this context could be very useful.
(e)    The lateral appointments should not become matter of lobbying and favoritism just like directorships in PSU Banks, PSEs and various development Boards and Corporations.
Chart of the day
 
Notes from my Diary
Continuing from yesterday (see here).
To manage any material change, especially in a large organization, it is very important to reinforce and embed desired changes in structures, processes, systems, target setting, and incentives. The change, to be effective, must presume that people don’t always behave rationally.
Reinforcing mechanism
Many studies have found that for human beings satisfaction equals perception minus expectation. There is not much evidence to prove that spending money on public utilities and providing subsidies and incentives directly motivates people to accept the changes proposed by government.
Sometimes small, unexpected rewards, which improve perception of voters, could materially enhance their satisfaction. To the contrary, major cash incentives falling short of expectations may actually lead to poor perception and dissatisfaction.
It is therefore important that the proposed change passes the test of "fairness and justice", implying that it should not only be in the interest of common public, it must be perceived by the public to be so.
Therefore, in implementing any changes that may have wider socio-economic impact, the politicians responsible for the change managers must pay great amount of attention to voters' sense of the fairness of the change process and its intended outcome.
Demonetization, GST, stringent tax compliance enforcement, etc., are some changes by the incumbent government that may not have been perceived to be totally fair and just, causing resentment and dissatisfaction.
To minimize the resentment, BJP has introduced an element of insecurity and danger in people's perception. Using Pulwama terror attack as background, a sense of urgency to secure borders, before ensuring socio-economic well being of people, was thrust upon voters. The perception has been enhanced through an unexpected airstrike in Pakistan's airspace, giving voters an immediate sense of security and well being.
Building capabilities
To make any change effective, it is critical that necessary skills and talent is developed in the target audience.
As governments attempt to drive economy by changing the way common people behave, they often neglect the thoughts, feelings, and beliefs that, in turn, drive behavior of people.
Social reforms are therefore equally, or even more, important than economic reforms for sustainable faster growth.
The sub-par performance of Cleanliness Mission is an important case in point. The Mission has not been adequately supplemented by behavioral training to people and capability building for civic authorities. No one in the country denies the need and importance of cleanliness; yet we see people littering, dumping domestic garbage in drains and open grounds, spitting in public places etc. This clearly indicates to lack of efforts in behavior management and skill building.
To conclude, I would say, the political establishment to which people want to assign power to govern, must only not possess a clear vision for faster and sustainable socio-economic development, it must be competent enough to manage the changes that may be needed for attaining the goals.
Also read

 

Wednesday, April 24, 2019

Managing change - a political perspective - 2



Some food for thought
"The evolution of sense is, in a sense, the evolution of nonsense."
—Vladimir Nabokov (American Novelist, 1899-1977)
Word for the day
Easter egg (n)
A hidden message, as a cryptic reference, iconic image, or inside joke, that fans are intended to discover in a television show or movie.
First thought this morning
The sitting MP from North West Delhi and Dalit face of BJP has openly "threatened" the party leadership that if he is not re nominated as candidate from his current constituency, he will quit the party (see here).
This type of pressure tactic is not uncommon during elections. Every party faces this as they try to find equilibrium between anti incumbency, winability, need to address aspirations of other stakeholders, need to give opportunity to new candidates, need to address the changed circumstances (united opposition, or changed demographics etc.) and above all need to benefit from some immediate event (e.g., sports victory, hit movie, civil unrest, war, terrorist strike, death of a candidate/potential candidate/public servant etc.)
The "top controlled" parties, who primarily rely on the personal charisma of their leader, are commonly seen to nominate candidates without much consultation with the workers on ground. However, cadre based parties like CPM and BJP have traditionally been known for mostly promoting candidates from their cadre only.
The trend in BJP however began to change from 2014 elections when a significant number of "outsiders" were nominated to contest election on lotus symbol. The 2019 Lok Sabha elections have seen the trend peaking, with the party nominating much larger number of candidates who have joined the party just a few days before securing nomination. These "outsiders" include retired bureaucrats, artists, sportspersons, defectors from other parties, monks, and other celebrities. This is obviously inspiring some dissent amongst the unsuccessful aspirants.
Admittedly, this is an internal matter of BJP, just like any other party, to decide who to nominate as party candidate, and who not to nominate. But a traditional BJP voter may want to consider the following, before casting his vote:
(a)   Will the candidate I am voting for, represent me adequately in the parliament? Will he/she be committed to raise my issues in the parliament and adequately seek redressal of my grievances from the government?
Unfortunately, the empirical evidence suggests that the track record of most celebrity candidates has been completely unsatisfactory in past couple of decades at least.
(b)   Is BJP degenerating into a "top controlled" party (like Congress, SP, BSP, RJD, Shiv Sena, DMK, AIDMAK, et. al.) where the opportunities for "cadre" are getting limited?
(c)    Does BJP leadership, like Congress and other parties, also want more non-participating members in parliament, who would support the High Command actions without questioning the appropriateness or rationale behind such action?
(d)   Is it a vote for prime minister or someone who will represent the voters in the Parliament?
National Security, incidentally is a collective responsibility of all citizens. The 790 members of parliament who represent all citizens of the country, are duty bound to ensure that adequate measures are taken to guarantee internal and external security of nation.
(e)    The last, but not the least, if the world's largest political party could not find 425 odd candidates from its own members, there must be something seriously wrong somewhere!
Do you recall how celebrities rushed to join AAP in 2013!

Chart of the day
Managing change - a political perspective - 2
Continuing from yesterday (see here), let's now try to analyze the 2019 election strategy and campaign narrative of BJP. It is however very important to note that I am analyzing BJP poll strategy because it is the largest party in the country, and currently in power at center and largest number of states. It is without prejudice and has nothing to do with my political preferences.
A compelling story
In 2014, BJP secured massive mandate and wrested power from Congress led UPA after 10years, by impressing upon people the urgent need for change.
The narrative was that policy paralysis due to passive leadership, pervasive corruption, cronyism, dynastic politics etc has caused tremendous harm to the economy and image of the country and therefore people must chose a decisive leader (Narendra Modi) who has proven track record (as Gujarat CM) of honesty, integrity, execution and has demonstrated a great vision for modern India.
Traditional RSS/BJP narrative of making India Vishwa Guru (Global Leader) again by restoring the glorious Indian traditions and knowledge had been tried many times, but it failed to impress poor, backward and oppressed. It only helped keeping the urban middle classes within BJP fold.
Therefore, to appeal to a wider section of population, and to some extent to obliterate the stigma of 2002 communal riots in Gujarat, a strong commitment was made towards "inclusivity" (Sabka Saath Sabka Vikas). To address the changes in electorate demographics in past 10years, aspirations of youth were also kept in prime focus with promise of Achhe Din through jobs.
People living north of Deccan Plateau bought the story and gave unprecedented mandate to BJP.
However, in execution, BJP appeared divided between its traditional "Cultural (Hindu) Nationalism" agenda and promise of inclusive growth. Consequently, it has been unable to fully satisfy its traditional middle class Hindu supporters as well as newly acquired poor and backward class voters.
The BJP leadership now fully realizes that voters cannot be motivated by Ram Rajya narrative as it has inter alia (a) failed in solving the contentious Ram Mandir issue; (b) not been able to usher a Hindu renaissance despite its half hearted "Cow Protection" campaign; (c) been tentative in taking a stand on Sabrimala issue; and (d) tacitly supported decriminalization of Section 377 of IPC.
They also realize that they have not been able to address all the concerns of minorities, poor, and backward. In fact, considering the fiscal and political constraints, it is not at all possible to satisfy all groups, regions and communities etc. Moreover, their commitment to core agenda of Hindu Cultural Nationalism may also have annoyed some minority groups.
On the economic policy front, the incumbent government did implemented some radical changes like replacing Planning Commission with NITI Aayog and Demonetization of high value currency, etc. The government apparently made most of these changes without preparing a conceptual framework and impact study. In some cases (e.g., NITI Aayog) it did not bother to convince people about the need and importance for the change. In other cases (e.g., Demonetization) it miserably failed in convincing the people at large.
Consequently, the story which appeared very convincing in 2014, has been totally dropped, and a residual story of "threat to National Security" and "Modi the Saviour" is being narrated at high pitch. The opinion polls suggest that this story is actually selling. In past, Mrs. Indira Gandhi had used this story effectively and successfully many times.
Role modeling
Role modeling is one of the most critical aspects of change management, especially when it comes to managing behavioral changes.
The incumbent government sought to induce many behavioral changes in common man, through public policy, administrative initiatives, and statutory pronouncements etc.
Some major initiatives included (a) Cleanliness; (b) Tax compliance; (c) Digital payments; (d) Sustainability (renewable energy, public transport, plastic use, river rejuvenation etc.); and (e) self reliance (less reliance on subsidies, self employment, Make in India etc.).
Conventional change management requires that leaders should take actions that role model the desired change and mobilize a group of influence leaders to drive change deep into the target group.
We have seen images of prime minister travelling by metro, picking a scrap paper and putting it in pocket on a dais of large conference, standing with a broom, taking a dip in Ganga etc.
But unfortunately, the change has not percolated down to a typical BJP supporter. The party has not administered any oath to its 100 million members for maintaining cleanliness, not using plastic, prefer use of public transport, using Swadeshi, and comply with all tax rules in letter and spirit.
The people do commend the noble government initiatives, the voluntary compliance level is far from the desired level.
...to continue tomorrow