Thursday, August 09, 2012

Passion, Compassion, Oversight

Social Enterprises are the flavor of the season. We are now not only talking about newer enterprises, but also getting back to the older iconic institutions and checking out whether they fit into the new nomenclature. Earlier they used to be just called non-profits or charitable institutions. But clearly the times have changed. The book on Sankara Nethralaya is written with passion and admiration and what started off as a not-for-profit affordable eyecare hospital has been retrofitted into a new framework of social enterprise. I say retrofitted because the authors write with passion and compassion but forget to bring out the “enterprise” aspect of the organization clearly.

What do we mean by enterprise aspect and how are social enterprises different from plain charities and non-profits? While that is up for a larger debate one way of defining a social enterprise is to look at how close it is to a business model in operations while how farther away it is from the accumulative tendencies of a for-profit. This is indeed a difficult test to apply, but worth engaging with. If we were to engage with this debate, the book disappoints because it does not talk in detail about the revenue model of the enterprise. Somewhere in the text is tucked away the fact that most of the investments and expansions are funded by philanthropic sources while the organization is self-sustaining in its operations. We also get to know from the book that cleanliness, hard work, a punishing work schedule and discipline are what drives the hospital. However, we do not get to know much about the operating philosophy, the management structures and the internal models that makes this enterprise tick.

This does not mean that the book is not delightful. It is eminently readable, with many anecdotal details put in. It is also very innovative in its presentation divided into nine chapters starting with the origins of the idea, how it grew in the initial phases, its ongoing lifelong relation with the patients, the impacts, initiatives and a peek into the future. Each chapter is accompanied by a section that brings out the specific achievements of the hospital in the context of the chapter and then followed by a brief but delightful expert commentary by some leaders who have known Nethralaya – including people like Dr.Prathap Reddy, AM Naik, Deepak Parekh, Gopalkrishna Gandhi and Rahul Bajaj. It is a format that is innovative and brings a bit of the outside perspective to the narrative.

Having said this, there is always an expectation from such inspirational books to understand why such enterprises tick, what drives them and why they are sustainable. Unfortunately the book does provides neither a framework nor an analysis to understand Nethralaya. We do not have any insights into the management processes, the revenue model and the overall operating philosophy about Nethralaya. This is quite unlike the case of Aravind Eyecare where there is an overwhelming personality of Dr.V giving his vision and also the systems that follow up on his vision. I am about sure that Dr.Badrinath of Sankara Nethralaya has that sort of a vision and systems in place, but the book does not capture it in great detail. The introductory part tells us that the authors wanted to write a biography of Dr.Badrinath, the person behind Nethralaya but the doctor insisted on the hospital being written about than himself. There was a point in this. Because if you write about the hospital, then one would to the extent possible look beyond the passion of the promoter. Unfortunately the authors fail in providing that perspective in their enthusiasm to paint a great picture of the promoter.

For instance talking about cataract operations the book mentions that while doing 50 cataract surgeries is the norm among opthalmologists, the doctors in Nethralaya are happy with around 20 surgeries [p.294]. We know that Aravind Eyecare thrives on large numbers because they argue that the best way to spread the capital costs on costly equipment is to ramp up the numbers so that the cost of individual surgeries are brought down. Why 20 is a good number is not clearly argued in the book either from the economic, hygiene or effectiveness point of view. This is stated as a fact and the rest of the argument trails on simplicity of life and not being ostentatious. This laudatory and idolatory approach of the book is its main failing.

I am about sure that there is much more to Nethralaya than the patient endorsements, industry endorsements, achievements etc., that are listed in the book. There is something for enterprises in this space to learn from the experiences of Nethralaya very much the way we have learnt from Aravind. This learning would have accrued had the authors removed themselves from the position of admirers and just moved to students of organisations. Their need to tell the story is greater than their need to understand why Nethralaya works. That is the undoing of a rather informative and delightful book.  

Sankara Nethralaya’s Passion for Compassion
VV Ranganathan, George Skaria and Meera Prasad
Lone Tree Books, 2012

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