ORGANIZATIONAL UNDERSTANDING

OBJECTIVES OF THE STUDY

We undertook this study with some of the following broad objectives in mind.
Some others were added later.
To develop an understanding of an organization
– how it functions
– what are the different components of the organization
– how different components interact with each other and with the
environment
– how changes in the external environment affect it
– its strengths and weaknesses
– where it has come
– where it could be and how
Of the above stated objectives, we could, to a reasonable extent, achieve most of the
objectives. The limitation was in terms of the basis for certain judgments we have
made. At times we had to draw from different people’s opinions, and conclude about
something.

METHOD FOLLOWED
The following are the data sources we used to get the data on which we based our
inferences and conclusions:
• Primary data
– Semi-structured interviews with employees at various levels
• About 45 employees of the organization were interviewed.
These included 15 doctors, 10 nurses, 5 managers, and 10 other
employees. We went to talk to them with a one page
questionnaire consisting of questions related with job
satisfaction, perception about the organization, mission vision,
etc. This was only a way to start the conversation. The
conversations led to the identification of several issues in the
organization. Many inferences about the organizational
conflict, HR issues, etc. were drawn from these conversations,

1
 and the informal interactions with some of the employees. We
took care of finding about the possible biases and prejudices of
the respondents. Triangulation of the information was also done
because many employees were interviewed.
– Informal interaction with the employees
• During the time of the OTS, we had opportunities to interact
with many of the employees in an informal manner. Especially
the team involved in the marketing efforts for KRUPA, the
social security scheme, was very helpful and we had several
interactions with the team members. Many issues came out
which we explored in the semi-structured interviews as well.
– Observations
• Just spending time in the premises led to some observations
which gave us some idea about how the organization functions.
For example, when our reporting officer had to send a written
application to the systems department for every piece of
information he needed, it showed something about the level of
centralization in database management.
• Secondary sources
– Annual reports
• Last two years’ annual reports were referred.
– EDP reports
• These were the reports generated by the systems department. It
was the main source of numerical data.
– Other literature
• The most important document under this heading is the Vision
2010 report. It was the report about the workshop organized by
the organization to chart out a strategy for its future.
• Some internally generated reports about the organization were
also referred.
• The website of the organization was also an important source of
data.
• The Organization Understanding Report for the organization
prepared by PRM 24 students was also referred.

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INTRODUCTION
Set up by the late Dr. H.M. Patel, the Charutar Arogya Mandal was set up with the
purpose of providing the best facilities for medical care and medical education to the
people of Charutar. Founded in 1972, the Mandal created the HM Patel Centre for
Medical Care and Education at its 100-acre campus in Karamsad. The Centre includes
five institutions:
 Pramukhswami Medical College
 Shree Krishna Hospital
 GH Patel School of Nursing
 LP Patel Institute of Medical Laboratory Technology
 KM Patel Institute of Physiotherapy
It’s Chairman and Executive Head is Dr. Amrita Patel who also serves as Chairman of
India's National Dairy Development Board.
Table 1: Details of the Organization
Address Charutar Arogya Mandal,
Gokal Nagar (Karamsad )
Anand -388325
Gujarat, India

Telephone
(02692) 222567, 222130, 223666, 223716,223010
Number
Fax (02692) 223466
Email sandeep@charutarhealth.org (CEO)
dilipjose@charutarhealth.org (GM)
Website details www.charutarhealth.org

MISSION AND VISION1

In this section, we present the core values, shared values, mission, visionary
goal, and vision of the organization as stated in its annual report.

Core Values:

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 Solace for the suffering is the motto of the Charutar Arogya Mandal. It aims
to heal, to soothe, to look to the well being of the underprivileged and to provide high
standards of Medical Care, Medical Education and Medical Research. The
organization seeks two essential qualities from all its employees i.e., compassion, and
commitment.

Shared Values:
Integrity: To maintain highest ethical standards, trustworthy, honest,
financially and morally accountable, efficient and effective use of all
resources.
Excellence: Be experts and leaders in all that we do with emphasis on
professionalism.
Visionary: Do the work with conviction, high motivation, working together
towards a common goal and mission.
Inclusive: Reflective and representative of all people and communities in the
area of operation.
Sensitive: Respectful of the unique qualities of others, open and responsive,
treating all with dignity and equality, appreciativeness.

Core purpose or Mission:

The organization’s mission is to:
• Provide comprehensive and personalised health care to the patients with
commitment and compassion at an affordable cost, to their utmost
satisfaction, while keeping ourselves abreast of state-of-the-art technology.
• Provide an environment conducive for excellent teaching and learning to the
students so that they become excellent health care professionals of the highest
calibre, sensitised to the health needs of the less privileged and equipped to
carry out ethical and value based practice.
• Deliver need based health programmes to the community, especially in the
villages, that lead to improvement in the health standards of all and also
contribute to national health care policies and practices, and doing so by
networking with other institutions having similar mission; and also
conducting innovative and interdisciplinary research relevant to the

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 community, striving always towards improving health standards and
practices.
• Create a work culture in the organisation that promotes a sense of belonging
and accountability, leading to overall growth and development, both of
individuals and the institution, maximising job satisfaction through job
enrichment.

Visionary goals:
To become the most reputed medical college in Gujarat and to establish itself
as one of the best hospitals.

Vision:
Charutar Arogya Mandal strives to be a Centre of Excellence in all the
activities it has undertaken: patient care, teaching, research and extension.
Patient care:
 We will serve our patients with commitment, compassion, and provide
comprehensive and personalized quality health care, ethically at affordable
price aiming at utmost patient’s satisfaction.
Teaching:
 As a teaching institution we will create and sustain an environment
conducive for excellent teaching and learning so that the health care
professionals prepared are of the highest caliber.
Research:
 We will conduct and promote innovative and interdisciplinary research,
relevant to the community aiming at improving the health standard and
practices.
Community extension:
 We will reach out the community for need based delivery and action
oriented comprehensive health programme.
 Awareness of disease and institution.

ACTIVITIES AND CONSTITUENTS OF THE ORGANIZATION

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 In this section, we would take a look at parts of the organization engaged in
various activities that the organization performs. The section provides some basic
information about the institutions performing these activities. In addition to this, at the
end of each section, there is a Strength-Weakness-Opportunity-Threats Analysis, i.e. a
SWOT analysis of the concerned activity. Most of the points in the SWOT analysis
are drawn from the SWOT analysis done by the organization under the workshop
arranged for charting out the strategies for its future. This exercise was organized by
the Mandal and it included people from the concerned parts of the organization. The
limitation was that it included only those at the top level in their departments. We took
these as the starting point and then, based on our observations and interactions with
people at different levels, excluded and included some points.

1) Teaching:
Pramukhswami Medical College-
Established in 1987, the Medical College is the pivot of the Charutar Arogya
Mandal’s activities. Initially founded as a grant-in-aid institution with Gujarat
Government's financial assistance, the college is now a self-financed institute. As an
autonomous institution, the College admits 100 students to its Medical Council of
India recognized MBBS course.
The College program includes opportunities for student participation in a
variety of community-based programs. It also runs a Medicine Bank to serve indigent
patients. The College organizes a variety of seminars/workshops conducted frequently
in addition to regularly held weekly multidisciplinary academic meetings.
There are five departments:

Anatomy
Anatomy is a foundation subject in the study of medicine. The Department of
Anatomy has a well-equipped laboratory, which prepares histological slides for both
training and research. Post-graduate and Ph.D. students have access to a specialized
research laboratory. The department has a museum, which includes a variety of
specimens (embryology, neuro-anatomy, histology and gross anatomy), radiological
and specialized imaging exhibits, charts and skeletons. The Department teaches

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undergraduate students and offers a two year M.Sc (Medical) course after M.B.B.S.
and plans are underway for MS (Anatomy) course also.

Forensic Medicine & Toxicology

The department imparts learning on the subjects of Forensic Medicine and
Toxicology to the MBBS students. The department also teaches concepts of Medical
Ethics, Court Procedures as well as methods for conducting proper examinations and
recording findings in Medico Legal Cases. Students are also taught to identify various
types of poisons and the management of patients of poisoning.

Physiology
The aim of the Department of Physiology is to equip students with a
comprehensive knowledge of the various organ systems, their functions, and the
physiological bases of health and disease. The Department provides theoretical and
practical training to physiotherapy students. The department, in collaboration with the
Sardar Patel University, conducts a program for engineering students doing a Masters
course in Industrial Hygiene. The department also runs a two-year M.Sc (Medical) in
Physiology course which can be pursued after M.B.B.S.

Pharmacology
The Hospital's formulary was developed by the department based on WHO's
essential drug list and the principles of rational drug therapy. The department supports
the hospital's Medicine Bank, which is supposed to provide free medicine to indigent
patients. The department's Manual of Practical Pharmacology, which incorporates
need-based teaching exercises, is the first of its kind in Gujarat.
A two-year post-graduate course of M.Sc (Medical) in pharmacology is also available.
Efforts are on for starting M.C.I recognized M.D (Pharmacology) programme in the
near future.

Preventive & Social Medicine (Community Medicine)

Preventive and Social Medicine Department is the backbone of all extension
services being provided by the Mandal. The department is involved in a number of
extension programmes of its own as well as in partnership with various national and
international agencies. It is involved in preventive, promotive and curative services in

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the form of health clinics, health surveys, health education etc. Through the rural and
urban health training centers at Ardi and Petlad, the department organizes multi-
diagnostic camps in various villages. The department has a tie-up with Tribhuvandas
Foundation for its ongoing cancer awareness and early detection project. The
department also runs post-graduate & diploma courses in Preventive and Social
Medicine.

LP Patel Institute of Medical Laboratory Technology:

The LP Patel Institute admits 60 students annually to a one-year Post graduate
Diploma course in Medical Laboratory Technology (DMLT). This course is
recognized by the Sardar Patel University. Those who complete the course are eligible
for intensive hands-on training at the hospital's laboratories, which offers a full-range
of modern laboratory equipment. Traineeship program has been designed with an
objective of an extensive hands-on practice to qualified, Medical Laboratory
Technicians in the different sections of medical laboratory including clinical
pathology, hematology, histopathology, biochemistry, microbiology and blood bank,
in order to enhance the expertise and skill. The students are provided with sufficient
academic interaction with the faculty to strengthen theoretical background.

KM Patel Institute of Physiotherapy:

Established in 1999, the Institute offers a four-year Bachelor in Physiotherapy
course affiliated to the Sardar Patel University. It is located within the Shree Krishna.
The students have the opportunity to work with the patients who visit the Hospital's
physiotherapy facilities. Thirty students are admitted annually.

GH Patel School of Nursing:

It was becoming difficult for the Shree Krishna Hospital to ensure a regular
availability of qualified nurses. Thus, in order to ensure this availability, the school of
nursing was started. It is a key institution in the Mandal's efforts to provide proper
medical care to the people. The Nursing Council of India recognizes the three-year
diploma course offered by the School. The School offers scholarships for
economically weaker students.

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SWOT analysis of the teaching activity:
Strengths: Weaknesses:
Adequate number of staff (as per MCI Lack of highly experienced teachers
regulations) High turnover (Mentioned in Vision 2010
Good facilities and environment report)
Regular academic activity Inadequate library
Opportunity for teachers to upgrade skills Students weak in English
Teacher training workshop Inadequate patient strength.
Opportunities: Threats:
Strong alumni Upcoming medical colleges
Physical proximity of university Litigations in court. (On the issue of
Training of medical officers admissions, etc.)
Government control

2) Patient Care:
Shree Krishna Hospital-

The hospital was established in 1981 with 136 beds. It has grown to 550 beds
and has become the largest health care facility between Vadodara and Ahmedabad. It
carries out several extension projects that take health services to the villages of
Charutar. The hospital has 14 operation theatres, medical, surgical, neo-natal and
pediatric Intensive Care Units, trauma centre, laboratory and radiology infrastructure,
blood bank, pharmacy. Patients can choose from amongst general wards, special bed
units and deluxe rooms. Outpatient departments, manned by diagnostic and treatment
professionals, are open to the public from 9:00 AM to 5:00 PM. Emergencies are
handled round the clock by resident medical officers, supported by consultants to
address more complex problems. The following are the departments of the hospital:

Anesthesiology
The Anesthesiology Department manages the Hospital's 14 operation theatres,
runs a "Pain-Management Clinic" and manages the Surgical Intensive Care and
Mobile Trauma Units. The Operation Theatres, 12 of that are centrally air-conditioned
with life support systems, are equipped with latest technology, like Boyles' machines,
circle absorbers, Isflurane vaporizers, Goldmen vaporizers, Laryngoscopes, pulse
oxymeters etc.

9
Biochemistry
One of the three arms of the hospital's Central Diagnostic Laboratory, the
department of biochemistry's diagnostic facilities includes Blood Gas, Electrolyte and
Semi-Automated Analyzers. Available tests include: Thyroid, Liver function, Blood
Urea, Sugar and Creatinine-Bilirubin (part of a liver function).

Dentistry
Equipped with three modern dental chairs, the department of dentistry's
outpatient service includes aesthetic and cosmetic dentistry and crown-down root
canal treatment as well as routine services. Cosmetic dentistry includes: composites,
ceramic crowns, pin restoration. The department is also equipped to meet more
complex dental needs, including periodontal flap therapy for loose teeth, regenerative
bone grafts, gingivectomy and crown lengthening, management of fractures, cyst
removal, emergency oral surgical procedures (e.g. surgical removal of wisdom teeth),
open methods of removal of fractured teeth, replacement of missing teeth by dentures
or bridges etc.

ENT
The ENT Department handles routine diagnosis and treatment as well as
surgery for head and neck cancers. The operation theatres are served by laminar
airflow and equipped with operative microscopes, EMG/BERA equipment and
Audiometry facilities.

General Medicine
The first point of contact for most patients, this department handles a wide
variety of common as well as complicated complaints. Malaria, anemia, diabetes and
thyroid problems are all managed by the department. The department runs specialized
clinics for diabetic patients on Fridays and for heart patients on Tuesdays, Thursdays
and Fridays. The Department's Intensive Care Unit is equipped with defibrillators,
bedside monitors and central monitoring station and dialysis equipment. Treadmill
tests and Doppler studies are also available to patients.
General Surgery

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 This department has 12-bed surgical intensive care unit, eight-bed
intermediate medical care unit and trauma & emergency care centre. The department
of surgery’s operation theatres are equipped with: Laproscopic equipment, Laprotomy
sets, Ventilators, Cardioscope with defibrillator, Pulse Oxymeters, Endoscopy with
upper GI scope, Fiber-optic and rigid sigmoidoscope, colonoscope, cyto-urethroscope,
and Video Endoscopy. The Department supports the undergraduate course and admits
two students annually to its postgraduate program

Microbiology
The department is responsible for HIV/AIDS (including Western Blot) testing
and has parasitology, mycology and bacteriology laboratories. The department
routinely conducts environmental sampling in sensitive areas on the campus as well as
at the hospital, testing the bacteriological quality of the hospital's water. The
Department's expertise in TB culture tests has led to a research project on multi-drug
resistant tuberculosis.

Obstetrics & Gynecology

The department runs four specialized outpatient services: High-risk pregnancy
clinic, Cancer & STD clinic, Infertility clinic, and Family planning clinic. The
department implements a post-partum programme in collaboration with the
Government of Gujarat. Working through 18 remote primary health centers, the
department implements a family planning programme. Its consultants also visit
Tribhuvandas Foundation's sub-centers to bring medical services to rural women.

Ophthalmology
The department’s facilities and its two operation theatres have recently been
upgraded with a Yag Laser, Operative Microscopes, Refractometer, Auto Perimeter,
Synaptophore and Slit Lamps. The Department's outpatient facilities have also been
renovated. It would also soon start a Retina Clinic, a first in the region, with the help
of Green Laser and Fundus Cameras.

Orthopaedics

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 The Department of Orthopedics carries out spine, joint, knee and hip
replacement surgeries. Its four Operation Theatres are equipped two C-arm IITVs and
pneumatic drills, among other things.

Pathology
The Central Diagnostic Laboratory offers round the clock routine and special
investigations in clinical pathology, histopathology, cytopathology and telepathology.
In an area where such services are not readily available, the AD Gorwala Blood Bank
supplies safe and tested blood to the hospital's patients as well as to other facilities in
and around. To ensure the safety of patients, every unit of blood is tested for HIV,
Hepatitis B and C, and syphilis. Blood donation camps are regularly organized in
villages, towns, institutions, factories and educational centers.

Pediatrics
Working with the Tribhuvandas Foundation, a community-based rural health
organization that serves the maternal and child health needs of 600 villages, the
department supports health service to thousands of children in Anand and Kheda
districts. The department also participates in multi-diagnostic camps, Pulse Polio
campaign, promotion of breast feeding, as well as training to Foundation health
workers. In addition to an ongoing vaccination programme, the department operates a
Well Baby Clinic, Immunization Clinic and Adolescent Clinic. When serious
problems arise, the department relies on its Neonatal Intensive Care Unit equipped
with a defibrillator and ventilator.

Psychiatry
This department is involved in:
- counseling intellectually and emotionally-challenged children and their
families
- conducting psychological testing
- providing cognitive behavior therapy
- offering marital and couples therapy
- counseling patients with HIV, serious illness and substance abuse disorders
- offering twice-weekly EEG testing for epilepsy, and
- providing ECT treatment for patients with major depression and psychoses.

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Radiology
The Radiology Department is equipped with six x-ray machines of different
capacities including portable units. The department also operates CT Scan Unit,
Mammography machine with automatic processor, Ultrasound machines, Color
Doppler, Electric dryer, IITV etc. The department's post-graduate course admits two
degree and two diploma students annually.

Skin
This department has a special focus on leprosy. The leprosy clinic provides
free leprosy drugs given by the Government. Patients receive physiotherapy and
receive education on prevention and cure of dermatitis in leprosy.
During OPD hours, the department offers cosmo-surgical procedures including Skin
pigmentation and peeling, Mini-punch grafting, Tattooing for Vitiligo patients,
Electric and chemical cauterization of warts, maevus, coms, skin tage, milia, Liquid
Nitrogen thermal cauterization of warts, corns, skin tage, condyloma accuminata,
milia and keloid etc.

TB/Chest
The Department is involved in diagnosis and treatment of a full range of
pulmonary diseases. The Department offers fiber-optic bronchoscopic examinations
each Wednesday. Pulmonary function tests are performed by spirometry. The
Department is responsible for undergraduate teaching on tuberculosis and chest
diseases.

Trauma & Emergency

The Shree Krishna Hospital is the recognized referral centre for all medico-
legal cases within 20 kilometre radius of Karamsad. The hospital's proximity to major
national and state highways leads to the utilization of its services for a number of
accident cases. To meet these needs, along with emergencies such as poisoning, burns,
emergency pregnancy, heart attack and snake bites, the Mandal established the
Shapurbhai Patel Trauma and Emergency Centre. The Center, which has an operation
theatre attached to it, is supported by a wide range of diagnostic and life-saving

13
equipment including ventilators, debrillators, sonographic and mobile x-ray
machinery.

SWOT analysis of the patient care activity:

Strengths: Weaknesses:
Only hospital of such scale in the region. Improper location (with respect to the urban
Adequate number of professionals customers)
Availability of services under one roof. Employee turnover (especially experienced
Round the clock availability of service. doctors)
Sophisticated and latest equipments. Patients’ information system is not adequate,
Critical care facilities. given the size of the hospital.
Shortage of proper communication channels with
the community
Opportunities: Threats:
Vast size of potential customer population. Competition from private doctors.
(because the only hospital of its size in the Distance from the community.
region) Poor image.
Association with other organization, like TF. Litigation in courts. (About negligence in patient
Develop as a specialized diagnostic care, etc.)
center/cancer/critical care.

Research:
The Charutar Arogya Mandal has established a separate research body called
the Chaturar Arogya Mandal Medical Research Society. The Society undertakes
research in the areas of epidemiological studies and the advancement of diagnosis,
therapy and prevention of prevalent diseases. The Society's work includes provision
of research facilities in related disciplines such as clinical sciences and community
health.

There are two committees: the Research Council establishes policy guidelines
for research and the Research Advisory Committee approves research projects that
conform to the guidelines. Since its inception in 1984, nearly 150 research projects
have been approved by the Society. 23 researches are ongoing and 8 researches have
been completed.

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SWOT analysis of the research activity:
Strengths: Weaknesses:
Ample subject-population Inadequate facilities for some researches
Research council grants. Lack of motivation
Lack of training/guidance
Inadequate library resources.
Interdepartmental tussle
Opportunities: Threats:
Grants from outside Competition for grants from outside.
Topics of research

The Extension Projects:

The Mandal has initiated numerous community-based Extension Programmes
in Anand and Kheda districts with emphasis on health education as an integral
element in all the programme activities. The three main goals of implementing these
community based practices are: promoting healthy lifestyles, encouraging behaviours
that prevent disease and empowering communities to formulate local solutions to the
problems they face. These are also the central principles of the Mandal’s vision for
implementing extension programmes. The Mandal has continued its efforts to adopt
more interactive and attractive methods to convey health messages to the community.
The network of Tribhuvandas foundation is utilised to reach out to the community.
These activities can also strengthen the Mandal’s ability to remain sensitive to the
circumstances and concerns of the population it serves.
The hospital has also responded to natural and manmade calamities such as
earthquakes and communal rioting with extension projects. Some of the extension
projects are:

The Anand Health Center

Mayank Jayant Foundation Bhawan of the Shree Krishna Hospital offers

medical care for Anand's people. It is located near the new bus stand in Anand.
Consultants in medicine, surgery, orthopedics and pediatrics staff the Center's evening
clinics. During the day a Medical Officer, supported by a laboratory, x-ray and
pharmacy, provides routine care. The services offered are very few, as mentioned

15
above. The timings have only recently been extended to the evening. The center can
provide an opportunity for the hospital to tap the market of Anand town. This market,
due to the distance from the hospital, remains largely untapped.

The Petlad Municipal Hospital

Petlad, a town of 50,000 about 20 kilometers from Karamsad, operated a small

municipal Hospital. The Mandal was invited to run the outpatient services of this
hospital. The Mandal provided a Medical Officer, a nurse, and a pharmacist-cum-
clerk to manage the Hospital.

The Ardi Project

The 5,000 people of Ardi live about 8 kilometers from the Shree Krishna
Hospital. No licensed medical practitioner lives in the village. In 1990, the Charutar
Arogya Mandal assessed Ardi's health needs and set up a comprehensive health care
program to serve this poor community. Operating out of a room in the Panchayat, the
Pramukhswami Medical College Department of Community Medicine (P&SM)
program conforms to the Medical Council of India's recommendation for a rural
health-training center. In the morning the Ardi Center is open for outpatient services;
during the afternoon the health team visits different parts of the village to collect
demographic information, impart health education and to identify patients who need
primary and secondary intervention.

Other extension

 Cancer Awareness, Education and Early Detection Project

 Tobacco Cessation Clinic
 HIV/AIDS Project
 Polio Project
 The Supplementary Nutrition Project for Pregnant and Lactating
Women
 State of Health Report for Anand and Kheda districts
 The Earthquake Project
 The riot relief Project- Initiative for communal harmony

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SWOT analysis of the extension activity:
Strengths: Weaknesses:
Rural location Lack of proper transportation
Extension centers Inadequate PHC-liaison
Industry association
KRUPA healthcare security scheme
School/college programmes
De-addiction programmes
Opportunities: Threats:
Vast rural community Increase in number of private practitioners
Ability to adopt villages Higher cost of medicines
General unwillingness of doctors to work in
villages

Support Services:
While the limelight is on patient care and academic activities of the Mandal, it
is also necessary to take stock of the functioning of the Support Services. These
departments, behind the scene, extend valuable functional support to all the activities
of the Mandal. The support services also liaise with external agencies, including
Government, ensuring statutory compliance and meeting donor requirements besides
making sure that all activities are consistent with the Constitution of the Mandal. The
Support Services include accounting and financial control, purchase, hospital
administration, materials management and maintenance, personnel & administration
and systems.

Accounting and Financial Control

All financial transactions of the Mandal and its units are carried out centrally
and accordingly the book-keeping is centralised. A computerized Financial
Accounting System, developed internally, is used for the purpose. The department is
also responsible for management of funds of the Mandal and for preparation and
review of budgets. The Mandal has adopted a system of concurrent audit of all
transactions by an independent firm of Chartered Accountants.

Purchase

17
 The department is responsible for all purchases of the Mandal. The purchase
procedures have been fully computerized. Last year, the department arranged a two
day training programme on “Materials Management” for Purchase, Stores, Accounts
and Computer departments of the Mandal.

Hospital Administration
The Hospital Administration of the Shree Krishna Hospital looks after support
services of patient care through its Pharmacy Counter, Food Services, Medical
Records Department and Central Sterilization Store.

Pharmacy
The Hospital's pharmacy has two goals: to make medicine available to patients
at the lowest cost possible; and to promote rational therapy among clinicians and
students. About 850 drug based formulations on WHO essential drug list are managed
by the pharmacy store. Eight qualified pharmacists man the counter round the clock.
The counter has recently been provided with modern storing facilities with the
purpose of optimal space management as well as better and quicker services to
patients. The pharmacy serves an average of 800 patients daily, carries an inventory of
more than 800 different types of medicines and has an annual turnover of more than
Rs. 2 crore.

Central Sterilization Store

The Department has the major responsibility for the Hospital's efforts to meet
hygienic and aseptic standards. Eight autoclaves of different sizes and capacities are
used to ensure that all instruments and materials used in Operation Theatres and
wards are properly sterilized.

Food Services
The Food Services department provides general as well as therapeutic diet to
all the general ward patients and special diet to special and semi special room
patients. The dietician provides diet counseling to outpatients and inpatients and plans
diets according to the nature of the disease. The department also provides snacks and
tea to the staff at their desk in the morning and afternoon at a concessional rate and
manages tea and coffee vending machines placed for patients and relatives. It also

18
caters to the food requirements of guests. The department actively supports the
Nutrition Project being implemented by the department of Obstetrics and Gynecology
for anemic pregnant women.

Medical Records
The Medical Records department handles all the medical records, X-ray and
CT scan films of inpatients. It receives records from the wards and verifies them for
completion and then files them in an orderly manner for easy retrieval. When
required, it makes available these records to doctors for either patient treatment or
study purposes. It also liaises with Government departments for vital statistics,
processing of medical insurance claims and medico-legal cases. The department has
three sections, viz. Current Records, Active Records Section for storing records of the
previous 12 years and Inactive Records Section which stores records of more than 12
years old.
Materials Management and Maintenance
Advances in engineering and information technology in the recent years have
brought about several changes in the field of medical science. Medical equipment
plays a very significant role in the healthcare delivery system. Sophisticated
biomedical equipment requires a host of utilities air conditioning and refrigeration,
stabilised power supply systems, etc. Hospital equipment falls into an extremely wide
spectrum ranging right from a hi-tech spiral CT scanner to a simple patient trolley.
The department manages stores of medical and surgical items; including implants and
minor equipment, Pharmacy, Laboratory, Housekeeping, Electrical and Electronic
items. The department is responsible for repairs and maintenance of electrical,
electronics and mechanical equipment.
Hospital equipment can be broadly classified into:
 Biomedical equipment
 Laboratory equipment
 Ward equipment
 Service support equipment
 Utilities and hospital furniture

19
 All these account for a major part of this hospital project cost, almost 40-50 per
cent. Of this, biomedical equipment could account for nearly 40 per cent of the cost.
Keeping this in view it is essential to ensure maximum utilization of the equipment
with minimum downtime.
Thus maintenance is an extremely important work schedule that is required to
keep any plant and machinery in a near original state of functioning for as long a
period of time as possible. This is different from repairs, which is the restoration of
such an asset to a condition as close to its original by replacements of parts and
overhauling of the asset. Maintenance management program has a very definite and
clear objective. It is meant to minimize repairs, allowing for maximum uptime/use of
the system, at minimum maintenance cost. It is essential to maintain a detailed history
of the system with the objective of improving maintenance and cost performance and
to maintain records enabling evaluation of the efficiency of the system, cost of
maintenance, and cost of repairs / replacements.
The concept of maintenance, as practiced in SKH covers preventive maintenance,
breakdown maintenance and monitoring of system efficiency. Hospital planners have
to formulate systems whereby minimum effort would be required in
maintenance/repairs in terms of tools, manpower and time through standardization,
safety, location, standby units, etc.
Standardization improves maintainability and reliability of the equipment besides
reducing cost of spares inventory. Safety would mean providing exact power supplies,
perfect grounding/earthing at every electrical point, proper location of equipment,
avoiding high voltage/ frequency areas and facilities.
Predictive maintenance detects trouble indicators in equipment, revealing any
unexpected deterioration taking place.
Computers play an important role in the maintenance of hospital equipment
and keeping record of their breakdown and repair history. Advanced biomedical test,
calibration and analysis equipment are available that greatly assist in the maintenance
of a wide spectrum of medical devices.
These equipments have the capability of downloading pertinent information
from the medical devices that can then be transferred to the main computer system.
This way the biomedical engineering department can log and keep track of the
performance levels of the medical devices during their lifetime. These computers can
be interfaced with similar systems in the hospital, wherever required, for easy access

20
to maintenance data from different locations. A proper control over maintenance
schedules, performance levels, maintenance costs and other related data etc. is
available through this information.
In conclusion, it must be stated that hospital engineers will continue to form an
important arm of the hospital staff and team. With the adaptation of proper
maintenance techniques and management systems one can utilize resources optimally
and reduce the breakdown and related maintenance workload.

Personnel & Administration

The P&A department provides the Mandal with services related to general
administration, housekeeping, estate management, legal services, recruitment and
personnel management. The department is also responsible for arranging regular
meetings of the Governing Council/Board and the Boards of Management of various
institutions and projects of the Mandal. As a first step in bringing all the institutions
under one umbrella, an effort was made by the department to streamline pay
structures and designations of the College and Hospital. A policy was also framed for
performance rewards to non-teaching employees. Thirty-three employees were
rewarded by way of promotion to a higher scale and forty four employees were given
lump sum incentives based on their performance, seniority and merit. The
department’s vision is to facilitate the functioning of the Mandal by timely action in
providing support services and ensuring harmonious human relations through
employee satisfaction.

Systems
Usage of cutting-edge technologies has helped the healthcare units like
hospitals to deliver best possible services to the patients. Doctors and surgeons have
been benefited a lot as they are using state-of-the-art equipment and technology to
perform complex surgeries.
The Systems department maintains an on-line integrated patient management
system running round-the-clock all through the year with almost zero down time. The
Laboratory Reporting Software, Financial Accounting Software and Payroll
Processing Software have been integrated in-house. A central computer facility
comprising about 6 computers with Internet connectivity has been made available to

21
the Medical College Library. Internet connectivity with ISP was switched over from
wired to wireless in order to eliminate disruptions.
Management Information System (MIS) has simplified the process of
recording patients' history, billing, generating pathological reports, and data storage.
Implementation of MIS in hospital has helped them to scale down the time involved
in admitting patients and even discharging them.
In order to ensure complete data integrity and privacy, the security design of
the system has been made to comprise of user names and passwords as well as
terminal-level and date level security.
The Audit Trail feature of the system is one of the security features that keep
track of creation/modification of data in the database by recording the operator, date,
values, etc. for the data that have been manipulated. The system has been working at
the 550-bedded Hospital & Medical collage. The department has also designed
programs for the KRUPA department.
There were complaints from KRUPA department about the highly centralized
nature of information management. This prevents them from accessing the relevant
information on time in order to take important action. Every time any information is
required, even that which was originally generated by the department, the manager is
supposed to write an application. The response sometimes takes several days.

COLLABORATIONS WITH OTHER INSTITUTIONS

The College is collaborating with Charutar Vidya Mandal for conducting a
course on Industrial Hygiene. This course is supported by the University of
Cincinnati, USA. Collaboration for the Master’s Programme in Social Work, with the
Faculty of Social Work of the Sardar Patel University also continued. Classes for the
subject ‘Hospital Administration’ for the BBA course continued to be conducted
within the hospital premises by the college staff.
The Department of Pediatrics supports the Government of India project for the
surveillance of Acute Flaccid Paralysis in cases registered with the Hospital. The
department also sends regular monthly reports to the Government for vaccine
preventable diseases surveillance. It collaborates with the local primary health centre
for regular immunization of children. In collaboration with the Government of India,

22
it is involved in a project for the prevention of transmission of HIV from mother to
child.
For the Environmental Engineering course run by the Institute of Social
Science and Technology for Advanced Studies and Research, the Departments of
Physiology and Pharmacology conduct classes on ‘Environmental Toxicology and
Physiology’. Academic assistance to the Homeopathy College and Physiotherapy
College (both at Anand) is provided by the Department of Anatomy.

OPERATIONS AND TARGET SEGMENT

The organization is working in the healthcare sector and the scale of
operations is mainly regional, catering the needs of the people of Anand and Kheda
districts.

The hospital ranks as a tertiary care centre. The target segment of the hospital
has been the rural community until very recently, when the hospital also started trying
to cater to the urban category as well. The rural community continues to have
importance, as it forms around 50-55% of the patient load of the hospital. But by
gradual improvement in quality of service and modern facilities, it became a preferred
choice of urban people also. The hospital has also tied up with the workers of the
Tribhuvandas Foundation who send women who are in need of nutrition, highly
anaemic women, as well as pregnant and lactating mothers who are in a very weak
condition to the hospital, to recover and regain their strength. Extension programmes
are conducted with the aim of reducing the prevalence of disease through screening,
early treatment, and health education dissemination to enhance and promote healthy
lifestyles. The extension programmes seek to bring about holistic health along with
community development.

In teaching activities, the needs of students from across the state are sought to
be catered. The Charutar Arogya Mandal has taken its teaching activities a step
forward with the establishment of a Post Graduate Medical College in addition to the
Pramukhswami Medical College, which teaches Medical sciences at the
Undergraduate level. The schools for Physiotherapy, Nursing, Diploma in Medical
Laboratory Technology and Cancer Research Institute indicate that the complexity of
the organization has increased.

23
 The Pramukhswami Medical College draws students mainly from Gujarat and
some Non Resident Indian students, while the H.M. Patel Centre for Post Graduate
Studies draws students from all over the country and abroad. The Nursing program
and the Laboratory Technology program are open to any students who are interested,
although most of the students are from Gujarat since the courses are affiliated to the
Gujarat State Nursing Council.

TIMELINE
1972: Charutar Arogya Mandal formed and registered as a charitable body, both as a
Trust and as a Society.
24th January 1981: A 136-bed hospital started in the OPD building, with facilities for
teaching the basic disciplines.
May 1983: The foundation for the second building laid with a view to raising the bed
capacity to 550.
April 1984: The Mandal applied to the Sardar Patel University, requesting them to
process the proposal for a medical college.
17th June 1985: The Government of Gujarat inspected the available facilities of the
hospital.
11th August 1987: Shri. H.M. Patel applied for the sanction for the medical college to
start with effect from September and this sanction was granted 4 days later. The
Mandal had to complete all the preparations in just two weeks. During this period,
every employee worked overtime as interviews were held, furniture was bought,
equipment was ordered, and the College started functioning from September.
1st September 1987: Shri H.M. Patel inaugurated the college with these words, “In
this college we are going to prepare doctors who will be caring and compassionate to
the suffering humanity and who will always keep the patients’ welfare and well being
their primary and pivotal concern of their work and activity as medical practitioners,
apart from monetary returns. We are going to equip this medical college with the best
faculty and the best equipment and I have no doubt that in the years to come our
medical college will become a Centre of Excellence and one of the model and premier
institutions in the country, uniquely devoted to the mission of rural health in a rural
setting.”

24
1988: Shri Pramukh Swami Maharaj laid the Foundation stone for the college which
was named after him. The sanction of the State permitted an annual intake of 100
students of which 90 were selected by the State Govt. Central Selection Committee
and the remaining 10 were at the discretion of the Mandal.
September 1991: MCI inspected the College.
March 1992: Gujarat medical Council inspected the college.
November 1993: Shri HM Patel passed away. Dr. Amrita Patel, daughter of the
founder Chairman took over as the next Chairman.
1997: The College started Post Graduate degree in Medicine. The Government had
changed the policy from September 1993. So the college was able to take 50 students
on a payment basis, while the others were allocated merit seats by the State
Government Central Selection Committee. The State Government had an agreement
that it would pay the 90% of the deficit or expenditure, whichever was less, to the
organization through aid.
26 August 2003: CAM launched social security scheme KRUPA.

EVOLUTION
After the death of its Founder Chairman Late H M Patel the organisation went
through a Crisis of Leadership. This crisis was managed by giving leadership to Dr
Amrita Patel. She appointed new management team which includes CEO, GM and
other managers, but powers were not clearly allocated. This resulted into a crisis of
autonomy. There was no separate management team, and we were told that the
doctors were not following the instructions given by management during that period.
The next crisis was that of control. After the new management took over, the rift
between the doctors and non-doctors became very pronounced. After this, the roles
were clearly defined, as well as the scope of the authority of both management and
doctors. However, now what we see can be called the crisis of red tape and entire
system appears to have become bureaucratic.
The above stages in the evolution process have been demarcated on the basis
of conversations with some employees who have been with the organization for a
long time i.e. greater than seven years.

25
ORGANIZATION’S STRUCTURE
The organization structure of Charutar Arogya Mandal has been evolving over
a period of time.

Governing Council:
The Governing Council is headed by the Mandal President. It is the decision-
making authority of the Mandal. The Governing Council can be thought of as the
“stakeholders” of the Charutar Arogya Mandal as well as various persons from the
Municipality, the nominees of the Governing Body, and members co-opted by the
Council. It is they who are supposed to maintain the financial propriety of the Mandal.
They approve the budget and the other financial measures.
President- Vacant due to the demise of Dr. IG Patel
Vice-President- Shri CB Patel,
Members elected by the General Body and Donors’ Representatives

Governing Body:
The Governing Body of the Mandal is the Executive Body of the Mandal. It is
headed by Chairman of Mandal. It functions under the purview of the Governing
Council, which is a wider body with representation from donors, sister institutions
and members of Mandal in addition to the members of Governing Body. It works as
the operational arm of the Mandal and maintains accountability to the Council. In this
way, the checks and balances are maintained. The “owners” leave the implementation
and operations to the Governing Body but monitor their activities.
Chairman- Dr. Amrita Patel
Hon. Secretary- Shri Jagrut Bhatt
Dean- Dr. KK Sharma

General Body:
The General Body consists of all the members of the Mandal. The total
number of member as at March 2004 was 1877. The members are mainly donors. The
person who donates automatically becomes member of the General Body. This gives
them eligibility to participate in General Body and give their inputs for the betterment

26
of CAM. Initially some members were nominated by Dr. H.M.Patel but later most of
the donors have come forward by themselves to donate for philanthropic purpose.

Administration:
The administration consists of the CEO, GM, and the top management of the
Mandal, as well as all the department heads and principals of the all academic
programmes.

Organization chart:

27
 Chairman

CEO
GM

Dean P S Principal Principal Health project /

Nursing
Medical Colege of School of
Superintendence
Extension
College Physiotherapy Nursing Activity

Head Hospital Dy. Nursing

Add. of Administrator Superintendence
Manager Dept.

Student
section

Manager Manager Manager Manager Manager Manager

Accounts EDP Material Maintenance Hospital Project
Add.

Executive DM. DM Manager MRO, Diet,

Sr. Prog.
Ass.- material Admn Pharmacy
(software
-Billing&
and
cash
Hardware Executive
-Finance, Biomedical
division DM for
Budget Officers- tech,
-HRD
-salary Pharm, supervisors
-Personnel
Engineering
-Gen Admn
-Secretarial
Assistant
Programmer -Housekeep
s

Assistance
Executive
PR/
Marketing

Clerks/
Assistance

Sr. Executive

Officer New Officer

project Running
Civil

(Figure-1: Organisation chart)

28
DIMENSIONS OF ORGANISATION STRUCTURE

Complexity:
Complexity comprises of three parts: horizontal differentiation, vertical
differentiation and spatial differentiation. The organization is highly complex in terms
of vertical and horizontal complexity. The organization has low spatial distribution
because apart from the HM Patel Center, there are just two health centers in 2 rural
areas (Petlad and Aradi) and one extension center in Anand.
The departments are demarcated on the basis of the functions (accounts,
stores, system, maintenance etc.). From the CEO till the lower level employees, there
are various levels of hierarchy in the administrative and functional department, both
in the teaching institutions and hospital. The organization has around 100 different
designations. The hierarchy is complex because of the extensive range of
qualifications and experience of the doctors as well as the extensive range of
qualifications and experience of managers, each of which promotes them to a higher
designation. Also, there are more than 100 nurses and supporting staff, each of a
different stage in qualification and experience, and large number of support staff.

Formalization:
The service rules and regulations are defined in the service book, which is
given to the employees when they join. The Governing Body and the top management
set the organization policies. CAM has five different institutions and degree of
formalization varies from medium to high. Compared to S. K. Hospital, in teaching
institutions the formalization is high. So we can say the formalization is moderately
high in CAM. The job profile of the person who joins the organization is clearly
defined in an employee’s manual or handbook, but some variation in duties also
depends on the department concerned. They are given little bit freedom to prioritize
their activities in consultation with their next higher up in the department.
The written and unwritten rules, regulations and norms contribute in bringing
formalization in the organization. Socialization in the organization takes place by
training the employee under a senior from the department and also by spending some
time in each department to learn the values, norms of the organization. There are rules
in the organization; these are mostly to do with taking leave, and availing of perks,

29
etc. Procedures are highly technical and very crucial in a hospital. The extent of the
formalization varies from department to department and it partially depends upon the
department head. Each department has its own culture and a set of people who remain
relatively constant there. Most of the permanent employees get attached to a particular
department.

Centralization:
Among the top management, there is a division of powers between the CEO
and the GM for convenience and efficiency. The CEO deals with the Hospital
Administration Department, Personnel and Extension Projects. He also deals directly
with the heads of the academic programs i.e. the Dean, the Nursing School Principal,
etc. The GM deals with the financial matters, and the Manager Accounts,
Maintenance and Systems come directly under him. He reports directly to CEO. There
is delegation of authority to each of the managers with respect to their department.
The Heads of the teaching and Clinical departments are responsible for the
performance of their department. It is tough to say whether the centralization is high
or low.

ORGANIZATION ANALYSED BASED ON MINTZBERG’S MODEL

There are five basic part of any organisation. Any one of the five can dominate
an organisation. Moreover, depending upon which part is in control, a given structural
configuration is likely to be used.

The Techno structure:

The techno structure helps to standardize the activity in the organization. The
techno structure in S K hospital includes various committees, which regulate and
standardize the activities. There are several permanent and ad-hoc committees:
 HOD Committee: It helps to established better coordination among various
depart of hospital and medical college.
 Board of Management: It consists of the Chairman, the Honorary Secretary,
Dean, CEO, the Vice Chancellor of the Sardar Patel University, and other co-
opted members. It evaluates the progress of the Medical College.

30
  Free-ship Committee: This committee evaluates the paying capacity of the
patient and decides how much free-ship has to be awarded. It consists of the
General Manager and the Deputy Manager, and the doctor concerned with the
particular case.
 Other committees like Death Review Committee, Hospital Infection Control
Committee, Laboratory Committee, Radiology Committee, Nursing
Committee and Pharmacy Committee deal with department-specific issues.

The Operating Core:

The operating core of the Charutar Arogya Mandal consists of the doctors and
the paramedical staff, nurses, technicians in the diagnostic departments, computer
programmer in system, accountants and store keepers as the operating core.

The Strategic Apex:

The Strategic Apex consists of the Governing Council, Board of Governors,
the top management (CEO, GM) and the Dean and Heads of Departments of the
Mandal and deals with strategic and broad issues which concern the organization.

The Middle Line:

The Middle Line consists of the Managers and Deputy Managers who head the
functional departments and the faculty of Medical, Nursing and Physiotherapy
College.

The Support Staff:

The laundry, kitchen, maintenance, cleaning, waste management team, etc are
all parts of the support staff.

The operating core functions in accordance with their professional code of

conduct and ethics. There is a lot of technical expertise involved in the carrying out of
functions and to give standard result. There is social specialization rather than
functional specialization. The operating core in SK Hospital is essential element to
perform its core activity like patient care and teaching. For more customer satisfaction
the hospital should be in professional bureaucracy, but techno-structure dominates the

31
operating core, and the techno-structure which houses the analyst who does
standardizing has emerged as the key part of the structure. The existence of machine
bureaucracy is not very clear and apparent, but the system in the organization can be
most suitably described as a machine bureaucracy. Typically, in a machine
bureaucracy, rules and regulations are highly formalized, tasks are grouped into
functional departments, decision-making follows the chain of command, and there is
an elaborate administrative structure with a sharp distinction between staff and line
activities. These characteristics are, to a significant extent, visible in the organization.
The emphasis on standardization has extended well beyond the operating core. In the
process of some conflicts, there has come about a change in the nature of the
bureaucratic structure. With time the Shree Krishna Hospital has become more like a
machine bureaucracy where operating core seems to have lost a significant share of its
autonomy. A machine bureaucracy typically works well when matched with large
size, a simple and stable environment, and a technology that contains routine work
that can be standardized. Given the context of the organization, it is more advisable to
have a system which is close to being a professional bureaucracy.
A control mentality pervades it from top to bottom and alienates employees from
one another and from the goal of the organization, as each becomes more focussed on
carrying out his job. The central goal of patient satisfaction through excellence would
be lost, leading to a situation called goal displacement. Since operating core of
machine bureaucracy is not designed to handle conflicts well, many human problem
arise and administrative structure becomes ill suited to the use of mutual adjustment.
All the communication barriers in the structure- horizontal, vertical, status, line/staff
impede informal communication.

TECHNOLOGY
Technology includes the equipment, information, techniques and processes
available with an organization to transform input into output and carry out its
activities. The main objectives of the hospital is providing high quality service for
patient care and the development of graduate and post graduate programs of the
highest quality in advanced medical specialties. Decision makers are expected to
conceive and adopt new technologies to make it a centre of excellence for health
science studies and patient care.

32
Perrow’s knowledge based technology:
Perrow identified technology on the basis of kind of knowledge used. Perrow
looked at knowledge technology rather than at production technology. He defined
technology from two dimensions. The first was task variability. This was number of
exceptions encountered in the course of one’s work. The second was problem
analyzability, ranging from well-defined problems to uncertainty of problems. In SK
hospital there is high task variability, as there are many different types of patients to
be taken care of as well as students to be trained. But, the problem analyzability is on
the higher side, because in most cases there are pre-defined procedures to be
followed, both in the case of patients and the students. Hence we can put these
activities under engineering.

FEW EXCEPTIONS MANY EXCEPTIONS

NON
ROUTINE
ROBLEM ANALYZABILITY

CRAFT

PROBLEM ILL DEFINED

ROUTINE
PROBLEM WELL DEFINED ENGINEERING

TASK VARIABILIY

(Figure-2: Perrow’s knowledge based technology)

Technology to meet uncertainty:

Intensive technology represents a customized response to diverse set of
contingency. The nature of response depends upon the nature of problem and variety
of problem. Doctors face diversity of challenge in terms of patients with a number of
complications, which are hard to predict and find solutions. Thompson called it
technological uncertainty. Thompson classified different types of technologies, based

33
on the task that the organization performs. The actual response depends on the nature
and the variety of the problems at hand, and there is a lot of interaction and feedback
between the two or more unit.

INPUT

RESOURCES
A PROCESS
B OUTPUT
C
D

FEEDBACK
(Figure-3: Intensive Technology characterized by reciprocal interdependence)

Treatment is a combined result of various medical specialists, X-Ray,

Laboratory, and housekeeping services, and pharmaceutical services. There is
constant interaction between the patient and the service providers and there would be
a feedback from the patient. This is called reciprocal interdependence, the patients
being benefited from the service providers while the service providers keep on adding
to their knowledge bank to serve even better.

CULTURE
The organizational culture of CAM is characterized by two parallel sub-
cultures. One is the culture of managerial and administrative staff, and the other is that
of the doctors. The dress codes were enforced on the managers some time ago, but
such a code was not enforced on the doctors. The doctors anyway are easily
identifiable by their white coats. All the support staff wear uniforms, color coded to
represent their rank. This is especially convenient in the case of the nursing staff, as it
helps to identify between the ward nurses and the head staff nurse for a department.

The selection process is at least apparently not based on the person-culture fit.
The people joining the organization get socialized by their colleagues and superiors
and learn “How things are done around here”. This has both positive and negative

34
implications. The main negative point is that the new entrant may become prejudiced
about certain things in the organization.

The stories and rituals are the general tools of socialization. Some departments
have their own rituals and practices. For example, the KRUPA office has a culture of
celebrating birthdays and giving farewells to those leaving the office. One of the
reasons for changes in the organizational culture has been the entry of professional
management at different levels. Their entry has increased the level of enforcement of
discipline.

ORGANIZATIONAL CONFLICTS
The nature of the conflict in the organization is latent. There are undercurrents
of complaints and disappointment, but there haven’t been any widely known
confrontations. There can be said to be a doctor-management divide. This dichotomy
is not exact, but there appear to be two such broad groupings. Though within a
department, the relations appear to be good, there is some degree of difference
between departments. Open displays of confrontations and conflict are occasional and
have happened only between very few individuals. Latent conflict is not known to
manifest itself through bad behavior openly. However, this gives the impression that
everything is running smoothly. This could be dangerous unless the management is
watchful enough to track the extent of the rift.

HUMAN RESOURCE ISSUES

There are total 703 employees in the entire Mandal, including the hospital as
well as the educational and training institutes. Human resource management activities
play a very significant role in effective performance of any hospital, which depends to
a great extent on the quality of its staff.

Table-2. Number of employees:

Sl. No. Charutar Arogya Mandal
1. Doctors 136
2. Para-medicals 88
3. Supporting Staffs 55
4. Nurses 100

35
5. Residents Dr. 70
6. Interns 100
7. Employee of SKH 254

Hospital is a place where, on one hand, we have highly skilled personnel such
as doctors and on the other; we have unskilled workers such as sweepers. The
management presently prefers recruiting outstanding consultants in all fields of
medicine and surgery and skilled paramedical team. The applicants (doctors) should
have the appropriate qualifications (MD, MS, M.Ch in Orthopedic surgery etc.) They
are also recruiting paramedical personnel like physiotherapists, lab technicians, etc.
Here also applicants should have appropriate qualifications.
The Manager (P&A) told that the management had earlier been using the
traditional tools which are basically coercive in nature (such as, punishment,
suspension, degradation and discharge) to control the employees. Later it was realized
that these coercive measures were not very productive. Thus, modern management
tools were adopted and coercive measures were replaced by persuasive ones.
The claimed focus is now on converting the duties of staff into their habits.
Once the habits are formed, there is no need for reminders/ supervision and the staff
will become a very valuable asset for the hospital.

Recruitment and selection:

The P& A Department does all the recruitments for the different institution of
CAM centrally. The top management and the doctors come from all over India and
lower staff, nurses, technicians are mostly local. For recruitment at lower level,
administration normally gives advertisement in local news paper and demands resume
for required post. Recruitment is also done at the local level for the support staff and
the clerical workers through informal contacts. For the top management and the
doctors, ads are placed in the English newspapers and persons are interviewed before
they are appointed. The nurses are mostly recruited from the Nursing School itself.

Performance Appraisal:
Organisation has a system of a participatory and team-based approach of
planning and reviewing individual and group targets and their achievements. The head
of department decides performance appraisal in consultation with the immediate

36
senior of the person and feedback given by at least three employee of same level.
Each appraisee writes his objectives and result-oriented tasks within the framework of
the overall mission of the organization and each programme.

Promotion:
Promotions are considered on the basis of merit cum seniority. Seniority
carries more weightage. The competence is generally determined on the basis of the
recommendation by the senior manager or department head. In the case of doctors, the
basic qualification and experience carry more weightage than other factors, while in
all other staff promotions are mainly decided on the basis of seniority and
performance. Confirmation of new employees is based on the performance during
probationary period. Based on the performance as well as the seniority of the person
concerned, the increments and the promotion could change.

Training:
A new employee is generally kept on the probation period of six months,
following which he/she becomes permanent. During the probation period, the
performance in the given areas is monitored. Such new employees have to go through
training programmes related to the areas of works. And the duration varies from
department to department.

Employee turnover:
The organization has a high turnover rate of employees. Shree Krishna
Hospital, as an entity, interacts with its patients, through consultant doctors apart from
the regular employees. Some of the doctors have been leaving the hospital and their
exit has been attributed to reasons like low salary, tussle with management, negative
socialization etc. Although there are several perks, which have been introduced to
retain the doctors, the basic pay still can not match the returns from a private
establishment.

One reason why doctors leave is that they are dissatisfied with the
management’s way of functioning and they feel that they have too little professional
freedom. The management would like the doctors to work within a time frame, and to
achieve certain targets in terms of patient load, etc. The doctors feel that this is
unreasonable and that they should be allowed to have a say in setting of targets and

37
objectives. The doctors complain that the management treats the hospital as a factory
and an assembly line rather than a very delicate crucial service provider. For instance,
a doctor would look at treating a patient to the best of his capacity no matter what the
time involved, while management would think of all the patients still waiting for
consultation outside, in terms of a waiting line, and try to reduce that time. Last year,
i.e. in 2004, a time and motion study was conducted in the hospital. Doctors were
shown the results of the study and taken to task. Most doctors we interacted with
resented this study in an establishment like a hospital. They claimed that the study
was conducted because the people deciding about the study do not understand the
medical profession properly.
Table no-3 Employee turnover (Shree Krishna Hospital)
Years Joining Left
2003 40 33
2004 46 35
2005 (till June) 13 16

Table no-4 Employee turnover (Pramukh Swami Medical Collage)

Years Joining Left
2003 96 55
2004 94 102
2005 (till June) 49 38
(Source- P & A dept.)

Management also faces problems in dealing with doctors. There is a different set
of problems while handling them. Doctors, they say, may like to be controlled by a
senior doctor manager but not by a non-doctor manager. But in this hospital the
organization is managed by non-doctors. There are many reasons for the high turnover
and they need to be analyzed before any line of action is chalked out.
 Doctors perhaps have education/knowledge superiority when compared with
management professionals. They do not consider the management
professionals at par with them and therefore, there is a problem of adjustment.
 This hospital has doctors designated as medical superintendent or professors
who take care of the day to day administration of the hospitals as well as
teaching. So, doctors have been playing dual role. This also leads to some
resentment on the part of the doctors, some of who think that they have been
over-burdened.

38
  Pay and facilities are not according to expectation.
 Doctors are not taught management in medical colleges. For them, hospital
means doctor and doctor means hospital. So, they may not be educationally
equipped to appreciate the roles of management professionals in hospital
administration.

Earlier, a need was felt by Governing Council and Governing Body to hand over
the management jobs to management experts only. Doctors resented the move.
Doctors and management both need to change their attitude towards each other. Also,
the management professionals need to introduce the essence of participative
management while dealing with doctors. Doctors simply must not be ignored on the
ground that it is none of their business.
Also, there is need to develop positive attitude towards all the jobs of the hospital.
A doctor may have to be in operation theatre, say for six hours and it may at appear
tough but there is no shortcut to it. Similarly, a hospital administrator sits in the office
and manages the affairs from there. There must not be seen any luxury in it. It is the
demand of management profession. He can not move now and then. He has to sit in
the office and keep watch on various activities going on in the hospital. Since, he is
virtually responsible for everything in the hospital, he can not assign all the tasks to
himself. He has to delegate and keep the control in his hands and play the role of a
coordinator. Now, no comparison should be made between two jobs. The underlining
spirit should be - all jobs are important. Therefore, handling the staff is a real
challenging job. Sacking/suspension/discharge is an easy way out to get rid of the
staff we do not like but retaining them in job is a real difficult job and only an able
hospital administrator can do it.
However, it would be useful to conduct exit interviews and studies regarding the
working atmosphere, as the doctors have murmured against the management, without
bringing in any open confrontation. Listening to the patients would also be a very
useful way of keeping in touch with the environment, because patients would be able
to give their opinion about Shree Krishna Hospital as compared to other healthcare
providers in the vicinity.

FINANCIAL ANALYSIS

39
 The finance of the Charutar Arogya Mandal is heavily dependent on donations
for its sustainability. Financial resources are mobilised from the public, donors,
trustee’s contribution, which are in the form of a corpus fund, including the interest
earned on the corpus. This makes up a huge deficit, which has to be compensated
from the fees of the students of the MBBS and MD courses in the Medical College
and H.M. Patel Centre for Postgraduate Studies.

Figure-4: Sources of Funds

Source s of Funds

1%

1% Donations

24% Corpus

Guj Earthquake
74% Relief Fund
Membership
Subscription

(Source: Annual Reports of- 2001-02, 2002-03, 2003-2004)

The Income from Medical education has shown an increase of Rs. 1,70,12,920
or an increase of 26.2%. Similarly Expenditure has shot up by Rs. 1,21,57,510 or an
increase of 15.22%. However the gap between expenditure and income from Medical
Education is Rs.1,04,26,470. In the year 2002-03 expenditure exceeded income by Rs.
15281880 and in the current year it is Rs. 1,04,26,470 which translates to an increase
of 46.56%.
The Income from Medical Care has reduced by Rs. 49,22,750 or a decrease of
7.58%. But on the other hand expenditure has shot up by Rs.1,12,65,400 or an
increase of 14.35%. This leads to an overall increase in the gap between expenditure
and income from Medical care by Rs.1,61,88,150 (in the year 2002-03 expenditure
exceeded income Rs 1,34,85,120 and in the current year it is Rs. 2,96,73,270) which
translates to an increase of 120%.
Current ratio for the lat year was 0.50 and this year the ratio stand at 0 .22 and
this is due to both an increase of current liabilities by 12.61% and decrease of current
assets by 51.00%. The Mandal needs to work at the severe paucity of the working
capital being created and it could consider paying off some of its debts in order to
solve this problem. In an attempt to solve the problem of working capital it has taken

40
a Secured loan of Rs. 50,84,680 and has availed overdraft facility of Rs. 18,96,190
and this has increased the payment interest by Rs. 2,69,320.
The Mandal has kept a fixed deposit of Rs.7,39,154 with Charutar Nagrik
Sahkari Bank Ltd., since 15/05/2003. Further there is also a balance of Rs. 97,825 in
savings account with the said bank as on 31/03/2004. The bank has gone in to
liquidation. The claim has been lodged for the aggregate amount of Rs. 8,37,016 by
the Mandal on the bank.
For the year 2002-03 there was no Provision for Doubtful debts and this year
they have corrected that by creating a provision of Rs. 33,23,580 and this has also
contributed to increase loss by Rs. 18,409.25 (an increase of 408%).

ENVIRONMENT
It has been a tradition to celebrate the Foundation with a cultural program, and
the Founder Chairman, Shri H.M. Patel’s birth and death anniversaries are also
commemorated every year.
The hospital can be studied in the context of its environment by studying the
following four elements of environment: the hospital, its competitors (the alternative
value-providers), customers (the value seekers) it seeks to satisfy and changes in the
external environment (the value-migrators).
The following is the description of these units of analysis, which would
together give us a better understanding of the challenges and opportunities the
hospital has to face in the context of its environment.

Changes in the external environment:

Political and Legal

The hospital comes under the regulations of the Medical Council of India
(MCI) and the regulation due to association with the Sardar Patel University. MCI sets
the standard of employees recruited by the hospital. There are also minimum limits of
the number of doctors who need to be on the roll of the organization at any point of
time. Changes in these regulations can affect the hospital.
Government regulation, through the Sardar Patel University, also affects the hospital.
Recently the Mandal went to court against the government because of the changed

41
ratio of management seats to government seats in the PG courses. Such changes can
affect the organization.
Social
Social changes in the local community also affect the hospital. The changes,
like an improvement in the mortality rates, can affect the potential customer-base of
the hospital. A change in the health-seeking preferences of the local community can
also affect the hospital in several ways. A reduction in the tendency to seek
naturopathic treatments may present an opportunity to the hospital. Similarly, if the
health-seeking behavior moves towards private doctors, it spells trouble bell for the
hospital

Economic
The changes in the economic conditions of the local community affect the
potential and current customer base of the hospital. The poor community’s income
patterns need to be looked into, so that packages targeting them can be devised. Such
packages may help them and also help the hospital in increasing its customer base.
The funding from government grants and donors forms an important part of the
economic environment of the hospital. Changes in these funding can affect the cash
flows of the hospital significantly. This has happened in the past.

Technological
The field of medicinal technology is evolving fast. The process of evolution
needs to be followed diligently. Changes keep happening; if you stay behind, you may
end up losing a good part of the market. The Mandal has been able to have a good
performance on this front. It has managed to keep itself abreast with the changes
happening in the technological field. This is mainly due to the availability of funds
from the donors. The organization boasts of having state-of-the-art technology. This is
one of the major strengths of the hospital vis-à-vis its competitors.

Competition faced by the hospital

The competition Shree Krishna hospital faces mainly comes from private
doctors, some of who have set up specialty hospitals and nursing homes in Anand and
Vidyanagar. The hospital also faces tough competition from independent village
doctors. The situation is tougher because of the location disadvantage the hospital has

42
had to face. Moreover, the poor image in the some parts of the community also adds
to the toughness of the competition. The hospital doesn’t just need to compete with
other health service provider, but also needs to overcome the disadvantage of an
improper location and a poor image.
The nature of the hospital and competition can be understood by comparing their
strengths and weaknesses. The hospital’s major strengths are that it is the only one of
its scale in the region and that it provides almost all the frequently sought healthcare
services under one roof at an acceptable price. The competitors, on the other hand,
don’t enjoy these advantages. But, they have their own advantages. They are small
and agile. They are, not by choice but by virtue of pragmatism, empathetic to the
patients. The empathy can be seen in the hospital as well, but not of the extent seen in
the private doctors who thrive on personal connection with the patients. The private
doctors take a major chunk of the Out-patient market, and now with more small
hospitals opening, they enjoy a good part of the In-patient market as well. The doctors
in the hospital keep changing. Whenever a patient visits, he/she is very likely to meet
a new doctor. This may not matter to some, but it is important for many.
These factors, when coupled with the poor image of the hospital in certain part of the
local community and the strategically improper location with respect to urban
customers, pose a formidable challenge to the hospital.
Customers
The hospital was started with altruistic intentions, directed especially towards
the rural community. Some time later, the focus widened and the urban community
was also included in the plans. Recent times have seen an increase in the options these
people have in terms of healthcare-seeking destinations. There has also been an
increase in the expectations of the people, not just urban but also the rural customers.
The hospital’s poor image is due to many reasons, one of which is propaganda against
the hospital by some local elements.
The customer profile is very diverse, thus requiring a more focused approach on the
part of the hospital. It needs to be more participatory in its strategy-making. Proper
segmentation is very important. The concerns of different people can be met by
different strategic decisions. For example, equipping the Anand extension center
(Mayank Jayant) and positioning it as a full-fledged primary and secondary
healthcare-seeking destination could go a long way in taking care of the accessibility-
related concerns that the people have with respect to the hospital. It would help the

43
hospital in capturing some primary and secondary healthcare market from
competitors.
The Hospital
The following SWOT analysis of the hospital throws some light on the
Strengths and Weaknesses the hospital has, along with the opportunities and threats it
has to face.
Conclusion:
Looking at the Customers, Competitors, Change and the hospital, it can be
said that the environment poses a big challenge to the organization. The organization
enjoys certain distinct advantages over the competitors, it has the ability to supply
value to most of the customers, and it also has the strength to keep itself up-to-date
with the changes. On the other hand, there are certain strengths that the competitors
enjoy over the hospital, the problem of poor image among certain parts of the
community, and poor understanding of certain changes in the environment, especially
those of social and economic nature.

Strengths Weaknesses
Only general hospital of this size in the region. High turnover of experienced doctors
One-stop destination for varied services Low capacity utilization
Round the clock service Very poor reputation in some areas
Fund-rich and can keep itself updated with Friction between the management and the doctors
technological changes Lesser personal attention compared to the private
Good pool of donors doctors
A good pool of professionals to recruit from. Inter-departmental conflicts
Influential leadership Lack of proper networking with other similar
Cleanliness organizations
Social security schemes Costs of some services high
Opportunities Threats
Rural area-based institution with vast Negative propaganda by private practitioners and other
community around elements
Expanding patient care (cancer, super specialty Government policies of over-regulation
etc.), including tie-ups New hospitals
Special packages for urban and niche markets Litigations
Linkages with specialists and specialized bodies
Social marketing

44
 The organization will need to leverage its strengths, so that it can mitigate the
negative impact of its weaknesses. This would need a change in the tactics and
strategy of the organization. It would need to adapt to its environment. For example, it
would need to go deeper into the community, more proactively. This could mean
setting up small village health centers, or recruiting village health workers/volunteers.
The fate of the hospital would, among other things, depend largely on the decisions
taken by the organization on the basis of the above factors.
Lately, the hospital has taken some innovative steps to keep itself up to date with
the needs in the environment. Two major steps in this direction are:
- Social security scheme KRUPA.
- Treatment packages for surgeries.

THE SCORECARD OF THE ORGANIZATION- THE 3 MARKETS

The effectiveness of the organization can be judged in many ways. Here, we try to
measure the effectiveness by taking into account the performance of the organization
in the following three markets:
1) The Competency market: This consists of all the employees who can
potentially work for the organization.
2) The Commercial market: This consists of all the customers who can come to
the hospital for services.
3) The Capital market: This consists of all the donors who can come to the
organization for giving donation.

45
 Competency market Commercial market

Workers Community
H
cu osp

s
ee
st ita
om l’s

oy
er

pl
s

Em
Organization

Organization’s donors

Donors

Capital market

(Figure-5: The three markets)

In the above figure, the outer circles represent the entire markets, and the inner
circle represents the organization. For an organization like this, in an ideal situation,
you would have:
- The most experienced and committed employees working for the
organization for a long time for the organization.
- Enough people in the community preferring the hospital so as to keep the
capacity well-utilized.
- Most of the major donors patronizing the organization, with minimum
interference in day-to-day affairs.
We now take a look at the organization’s performance in these markets:

46
Competency market – Employees:
One of the most important things in the competency market of doctors is
experience. Medicine being an observational science, it becomes very important even
for the well-trained doctors to have some minimum experience in order to become a
good doctor. Thus, for a hospital, it becomes very important to get and retain the most
experienced doctors available in the competency market. On this front, the SK
hospital seems to be losing some ground. The hospital has been seeing a high turnover
of doctors, especially experienced doctors. The organization finds it easy to find new
doctors to replace those leaving because for a newly trained doctor the organization
provides a good learning opportunity. But most of the new entrants are far less
experienced than the ones who left. This leads to a certain dilution in the aggregate
competency level of the doctors of the hospital.
Some of the main reasons for leaving have already been discussed under the
Human Resource Issues heading. Doctors are Knowledge workers. Their knowledge
and skills are highly portable and can be employed almost anywhere there are sick
people, (or those who think they are sick). The doctors do not even need to work for
any other organization; they may very well start their own private practice. Thus, the
decision to leave an organization is easier for a doctor to take.
The situation calls for some immediate attention from those in charge, but it
doesn’t look like the matter is getting significant attention. The fact that no exit
interviews are held in the organization is indicative of this. Exit interviews could help
the decision makers create the enabling conditions for the people to stay.
Moreover, except in some cases, there is no culture of farewells in the organization.
Some doctors also complained that they had to do elaborate and tiring paperwork
before leaving. This paperwork took a lot of time and was very frustrating for them.
On the front of non-doctors, the situation is much better. In this competency
market, the hospital seems to be doing well. The turnover of this staff is only minimal.
The main reasons include: Hospital provides a good working opportunity and a
dignified status, limited alternative possibilities, and overall satisfaction.

Commercial market – People preferring the hospital for healthcare:

In this market, the performance of the hospital is significantly lower than the
potential it holds. Its capacity utilization hovers around 30-40%. Given the fact that it
is the only hospital of its kind and scale in the region, this is a disappointing figure.

47
The hospital is not a preferred healthcare seeking destination for many sections of the
target community. Our OAC study also indicated that the hospital is not a preferred
destination for many of the respondents. The hospital’s performance on this front can
be called below average to average.

Capital market – The donors:

The organization had received monetary help from several donors, both
institutional and individual. There is a very powerful influence of the donors in the
organization. They have a say in the Governing Council, the highest power in the
Mandal. They play an important role in deciding many strategic issues. Donation is
the major source of funds for the organisation. The very significant donors are critical
to the organization’s growth as most of the technological up gradation is done through
donated equipment or funds used for purchase of new equipment.
Some of the donors are charitable trusts, such as the Sir Dorabji Tata Trust,
Mumbai, and the J.V. Gokal Charity Trust, Mumbai. Funds also come in from the
Prime Ministers’ National Relief Fund. This has happened after the Earthquake in
Bhuj. Companies such as Larsen and Toubro also help with funds.
Individuals have been instrumental in donating various amounts of money, as
well as the funds for different wings of the hospital. All the institutes and each wing
of the hospital, and even some of the special wards, are dedicated to the name of some
person, (usually the donor’s loved ones, or the donor himself/ herself). These major
donations have come from individuals, mostly affluent Gujaratis from the area. Some
equipment manufacturers have also donated equipment to the hospital on account of
their rural mission and focus.
The performance of the organization in this market is good in terms of the
level to which it has been able to attract donations. But, this is a double-edged sword.
If an organization becomes too much dependent on such doles, it is not a healthy sign
for its long term sustainability. The donations should ideally be used in certain limited
ways only, like for technological up gradation and opening new facilities, activities
which the organization may find hard to finance on its own. If the organization
depends on the donations for its mere survival, it becomes a problem. There is more
on this in the financial analysis of the organization.

48
FUTURE COURSE OF ACTION
Having studied the organization from several different points of view, we now
try to present an “ought to be” scenario for the organization. Looking at something as
“what it is” can be only part of the understanding; we also need to take a look at
“what it could be” and “how”.
The following curve is called David Hurst’s Organizational model. We found it to be
relevant for the context of our organization.

Renewal Conservation

Crisis
Choice

Exploitation Creative-Destruction

(Figure-6: David Hurst’s Organizational model)

The organization starts its journey with a choice. This choice is a result of an
opportunity perceived by the entrepreneur. This journey doesn’t just start with the
starting of the organization. It may start by a re-alignment of the organization’s
priorities and strategic outlook. In the case of our organization, the Choice to start the
Mandal was made by a group of luminaries lead by Late Dr. HM Patel. He saw a need
for such a medical college-cum-hospital establishment in the region.
The next stage is of Exploitation. In this stage, the resources and enthusiasm
are exploited for growth and achievement of goals. Dr. HM Patel, along with other
people, got the resources like money, land and people together. These resources were
utilized and the organization was started.
During the course of its existence, the organization went through several
phases of growth and crisis, as described in an earlier section. This process of
evolution has led to the present state. The present state is characterized by
Conservation. This means that there is a tendency to conserve the status quo, the

49
existing systems. Generally, in such organizations, the questions asked and answered
are generally concerned with how things are done. The basic questions about why
certain things are being done at all are seldom asked and more seldom answered.
Something similar can be seen in CAM as well. This kind of a system has certain
rigidity in it. This rigidity may prevent it from adapting to its environment effectively.
Though a Crisis has not yet occurred, this does not mean there is no need to panic.
The heavy dependence on donors’ money is the main source of survival for the
organization. This may very well be hiding the real problems. The kind of capacity
utilization the hospital has may not be easy for a private hospital to sustain.
Thus, instead of waiting for the crisis to occur, it is advisable for the
organization to consider jumping the curve and doing some Creative Destruction.
Creative Destruction implies destroying anything so that it can be replaced by
something better. A system that fails to deliver in the markets of interest, for a
prolonged period of time, may deserve a consideration as a candidate of such
destruction. The Creative destruction has to be followed by a Renewal process in the
organization. The present system prevalent in the hospital could be replaced with a
system which could, among other things, be more participatory for the doctors. The
doctors need to be made to feel that they have a say in the organization. Such
possibility exists in a professional bureaucracy. The present machine bureaucracy-
type system is not doing much good. The problem may also be solved within the
realm of the present system, by making some changes in the system, but this is
unlikely to last long. The tendency for conservation would again take hold of the
situation.
The organization would need to make a new choice and embark on another
journey of growth. The choice we suggest should include changes at two levels, one
of which has already been mentioned:
- Restructuring CAM and
- Repositioning Shri Krishna hospital
The repositioning of the hospital and its extension centers would entail a great
effort from the entire organization. It would be advisable to precede the repositioning
effort by an internal restructuring of the organization.
Underlying all these changes, certain realizations are required for the organization.
These are based on our observations in the organization:

50
• Understand that the results lie outside the organization: Adding new facilities
and centers is of little use if the hospital has a poor image and is not preferred
by the people. The additions may help in getting some new patients, but it
would only be an incremental improvement. A more basic image makeover is
pending. The negative perception about the organization among certain parts
of the community may be changed if the organization proactively tries to
improve the image through image makeover campaigns.
• Need for genuine effort to win the trust of the community by going to the
community: Going to the community could mean setting up Village Health
Centers, recruiting village health worker/volunteers, or organizing more
preventive and promotive healthcare efforts, and so on.
• The organization should measure how it is doing with growth in number of
active customers’ commitment to them, customer retention, customers’
propensity to defect, customer referrals, customer acquisition costs, etc
• The organization should treat the doctors as if they are volunteers: A
volunteer works for satisfaction and likes to have a certain degree of autonomy
in his job. This satisfaction is what keeps the volunteer from offering his
services at other places. The organization needs to appreciate that the doctors
are knowledge workers, with high portability of knowledge and skills, and a
high degree of independence in decision making.
• Managers, especially the top level managers, should be integrators,
facilitators and allies.
• Donations-based survival is not sustainable in the long run
• Information should be available to those who need it: There is a great deal of
centralization of information in the organization. This leads to some problems
for some of the managers because they are able to access the information they
need on time. We felt this problem while working in the KRUPA office.
Information is a resource, like money. Money kept in a cupboard is not of
much use. It should be invested. Information also needs to be invested in order
to get returns.

51
 REFERENCE

1. Michael, J.M. Management theory and Practice, Little Brown and company,
Boston, 1979.
2. Paton, A Robert. McCalman, J. Change Management: A guide to effective
implementation, Sage Publication, New Delhi, 2000.
3. Kotler, P. Kartajaya, H. Repositioning Asia: From Bubble to Sustainable
Economy, John Wiley & Sons (Asia) Pte Ltd, 2000.
4. Robbins, P Stephen. Organisation Theory: Structure, Theory and Application,
Prentice-Hall India, 1990.
5. Annual Report (2002-2003 and 2003-2004)
6. www.charutarhealth.org
7. Dubey, Dash, Mishra, Ranjan, Rose. (2004), H.M Patel Centre for Health and
Education (Charutar Arogya Mandal), OU Report, IRMA.

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 ANNEXURE

Profiles of Top Management

Profile of the CEO

Name: Mr. Sandeep Desai
Education: B. Com (Bombay university, 1984)
C.A. (Institute of Chartered Accountants of India, 1988)
PGDRM (Institute of Rural Management, Anand, 1988)
Work experience:
GCMMF Ltd. (from June 1988 to January 1989 as Senior Accounts Officer)
NDDB (from January 1989 to December 2002 as Senior Executive)
Charutar Arogya Mandal (Chief Executive Officer, since July 2003)

Profile of the General Manager

Name: Dilip Jose P
Education: B.Sc. physics (MG University, Kottayam, Kerala, 1986)
PGDRM (Institute of Rural Management, Anand, 1989)
Work experience:
NDDB (from May 1989 to January 1996 in finance department)
Vadilal Industries Ltd., Ahmedabad (from January 1996 to October 2002 in corporate
planning and management services)
Charutar Arogya Mandal (General Manager, since October 2002)

53