The surgeon manager

The surgeon manager

Dr. Sanjay Cherian, VP and cardiothoracic surgeon at Frontier Lifeline Hospitals and a Ph.D. in cardiac surgery, decided to take a year off to study management. He is now implementing his learning in managing the hospital better and making it both employee and patient-friendly

POORNIMA KAVLEKAR

Why did you take time off to do a management degree after completing a Ph.D. in cardiac surgery? This is a question which the 37-year-old Dr. Sanjay Cherian, VP and a cardiothoracic surgeon at Frontier Lifeline Hospitals (Frontier) is often asked. He recalls, “Most people, especially close relatives, were not happy with my decision.” But he continues, “I realised that if you need to get an in depth understanding of management, there is no point in doing an online or part-time course as you do not get a real feel of management.” However difficult the decision, he took a year off from surgery to complete his management degree at Oxford Business School, U.K. in 2008-09.

At the heart of his decision was the desire to set right many administrative challenges that he faced in his life as a surgeon. “Before I completed this course, I was completely dependent on my finance manager, marketing manager and human resources manager,” he admits. This is typically the way a doctor-run hospital or nursing home is managed in India as doctors seldom understand management issues. At the other end of the spectrum are corporate hospitals run by management professionals, who are completely disconnected from medicine. “When you sit down at a board meeting of these corporate hospitals, you realise that there is always a tug of war between the finance person and the doctor,” shares Cherian. His aim is to strike the right balance between medicine and management at Frontier. While he is aware that the management degree has not made him a master of all these functions, it has surely given him diverse perspectives on various management issues and has helped him ask the right questions.

The balancing act

Cherian, who comes from a family of doctors, pursued his medical degree from Manipal University, India. Post which, he completed his Masters in Surgery from Australia, a Fellowship from the Royal College of Surgeons (U.K.), and a Ph.D. while working full-time and training in India. After completing his MBA in 2009, he worked in Switzerland as a staff surgeon till 2011, after which, he began his stint at Frontier from January 2012. His responsibilities here are both clinical and administrative in nature. “I try to wear two hats simultaneously by dividing time equally for these two responsibilities. But, sometimes, it does not work.” He has now slotted specific days for each role – Monday, Wednesday and Friday is dedicated to surgery while Tuesday, Thursday and Saturday are for administrative work. Yet, being a clinician he cannot completely switch off from medicine on his days as an administrator. “If a patient comes for a review you cannot say today is not my medical day, so I cannot do a review. There is always a bit of an overlap. But if you fix specific dates and specific times then it is easier on the system and on people,” he shares.

DR. SANJAY CHERIAN ON THE HEALTHCARE SECTOR IN INDIA

“India is unfortunately spending too little towards our healthcare services. The government should allocate more money towards this. The government is not able to provide quality healthcare to the masses. It has tried several times in several ways, no doubt, but has failed. Setting up a hospital is not the solution. What the government needs to do is to go in for public-private partnerships. The government has to only provide infrastructure and let the private sector run it. The main cost incurred by the hospital is towards land and infrastructure. And that is the reason healthcare is expensive. One of the good things that the government has done in some of states is to tie up with insurance companies. But it needs to structure the insurance schemes better.”

Management style

Cherian has developed a style of management where he involves his team in all the decision making processes. As a routine, his team meets every morning and sorts out daily issues. “We also have a monthly meeting with all the heads of departments,” he says. As a result of these frequent meetings, the team is able to review things faster.  “When there is a problem, instead of analysing the situation, if you listen to the inputs of your team, the chances are you are likely to come up with a quick solution. If people with a problem are given a chance to express themselves, at most times, they come up with a solution themselves and that is much better than something you can devise,” opines Cherian.

Meeting challenges

“Finding and retaining good nursing and administrative staff is always a challenge,” says Cherian. Most people view nursing as a career where they can go overseas and make good money. This issue is an ongoing process and all hospitals are working on addressing it. Frontier makes sure that it trains its nursing staff through an in-house training programme, irrespective of where the nurses get their primary training from. Apart from incentivising good performances, the organisation also helps nurses with their academic pursuits. “We sponsor them to attend national and international seminars, conferences and also to present papers,” says Cherian.

Adopting the Toyota way

The ‘Toyota Management System’ is Cherian’s favourite topic from his days at management school. The car maker, Toyota, improved itself on parameters like quality, efficiency and economy, based on inputs from its workers so that it could compete with General Motors in the U.S. market. He wants to ape this system and its efficiencies at Frontier. So far, this approach has helped Frontier in bettering its inventory management. “Inventory is a dead stock and takes a lot of money, space and manpower. We have been able to reduce our stocks parameters. We have a minimum order level and have gotten rid of a lot of extra stock,” explains Cherian.

This system also helps in time management when it comes to managing operating rooms (OR). The hospital has four ORs that run simultaneously, where it can perform around eight to 10 surgeries in a day.  And the hospital increases the efficacy of its staff by doing these surgeries in a day, without increasing the staff numbers. Cherian explains how. “A surgeon goes into OR 1 and operates on his first patient. His second surgery in OR 2 is started by the junior surgeons in such a way that the minute the surgeon finishes in OR 1, OR 2 is at the stage where he can walk in straight away and perform the main part of the surgery. Similarly, when the second surgery is completed, the surgeon has enough time to go back into OR 1 again to perform his third surgery. We overlap the surgery timings in such a way that our ORs are used more efficiently.”

Moving ahead

“In a hospital, the most important people are the patients and we need to keep that in mind and organise all the services around them,” says Cherian. Finance, no doubt, is important for every organisation, but Cherian wants to break away from the target-driven growth outlook that many hospitals have. “I do not want to calculate a return on investment or EBITDA on an annual basis by overlooking other factors,” he says. “There has to be a balance between finance and the quality of service that we give our patients,” he adds. To achieve this, Cherian aims to get feedback from every patient who visits the hospital. The patients fill a feedback form, which is monitored by the management team on a daily basis and action is taken on the weak points that are mentioned. Additionally, the hospital staff’s views are also taken into account. “We have a staff appraisal system not just for each other’s performance, but also to assess if our employees are satisfied with their work,” shares Cherian.

Cherian is now able to tackle the administrative challenges much better than before he completed his management degree and that is simply because he has had the time to put to practice all that he has learnt. He has built a strong team where each person has a voice. Importantly, Cherian has also established a review system that addresses the hospital’s weak areas in a swift manner. And with these management skills up his sleeve, apart from his expertise in using the knife, Cherian aims to strike the right balance between quality of service rendered to the patient and the economics of that service to the hospital. His methods are at the forefront of making Frontier both a patient and employee friendly hospital.


The Frontier story

Established in 2003, Frontier Lifeline Hospital is promoted by Padmashree Dr. KM Cherian, who is considered to be one of the pioneers in paediatric cardiac surgery in India. The Chennai-based hospital is a 120-bed hospital that specialises in cardiac care for both adults and children. Apart from Chennai, Frontier runs two other hospitals in Kerala. While they are independent units, they come under the Frontier Lifeline umbrella. It has an out-patient service for DaVita NephroLife, a medical centre, and a medical centre at SriCity, a SEZ. Over the next three years, Cherian aims to add another five to six branches within and outside India. There are centres outside India, which do not have any cardiac services, and Frontier aims to build cardiac centres on a partnership basis, where the partner provides the infrastructure and Frontier provides the services.

The organisation has also come up with a project called Frontier Mediville, a 360 acre bio-village, 40 kilometres away from Chennai at Elavur Village, Tiruvallur District on the Tamil Nadu – Andhra Pradesh border. “There are many good hospitals, medical colleges, research centres and biotechnology companies. Unfortunately, they are scattered everywhere,” says Cherian. Frontier Mediville aims to bring all this under one roof. This project has been primarily funded through internal generation and loans. Private equity partner, Jaipur-based Rajasthan Venture Capital Fund (RVCF) has also acquired  11 per cent equity stake in the company. Currently, the Cherian family holds around 67 per cent stake in the hospital while the rest is with private investors.


How does Sanjay Cherian manage his hospital better?

Holds diverse perspectives on various management issues that help him understand various functions better

Follows a participative type of leadership where he involves his team in the decision making process

Has different time slots for clinical and administrative work

Conducts daily meetings with the team and monthly meeting with the heads of departments

Takes feedback from the patients

Takes his staff’s views into account

Implemented Toyota Management System in the running of the hospital