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Hospital Operations Management and Gandhian Ideals

K. M. Mital Deepa Khanna

krishna.mital@iilm.edu deepa.khanna@iilm.edu

IILM Institute for Higher Education, New Delhi

1. Introduction Hospital operations management covers fairly large range of functions in a hospital as compared to well-known boundaries of operations management function in business. Harnessing full potential of hospital operations management is desirable in order for the hospital to stay cost-competitive, profitable and of immense service to the society at large. In any systems improvement exercise, it is important for a hospital to map out its own flows and interrelationships as only then some specific initiatives for efficiency enhancement, productivity improvement, quality control, etc. can be initiated, which all come within the realm of hospital operations management. Hospital operations management is concerned with applying traditional managerial functions (planning, organizing, directing and control) to hospital daily services, namely, outpatient services, inpatient services, emergency services and diagnostic services, and management of other activities such as hospital pharmacy, vendor managed and co-managed inventory control, supply chain management, warehouse management, pharmacy management, etc. Hospital operation management includes all day-to-day activities that it is busy all throughout the day but functions particularly marketing, accounting and finance, and HR, but no less important are usually kept out of its scope. This is because unlike outpatient or inpatient services; marketing, finance and accounting, and HR are not daily routine activities (Mital, 2011). However, at the same time addressing all major activities within the realm of hospital operations management is more important than narrowly limiting its scope on academic angle as real objective of hospital operations management is rendering more effective, efficient and productive services of world class quality than excluding some really vital activities from its fold on academic reasoning. Hospital management can be defined as entire hospital operations management plus HR, marketing and finance, and a few other hospital clinical and administrative functions. A patient visit to a hospital creates flurry of activities in the warehouse, pharmacy and dispensing counters, which keeps associated hospital vendor-managed or co-managed inventory systems including the supply chain in active mode throughout the day. Hospital warehouse, pharmacy, vendor-managed or co-managed inventory control, and supply chain management are thus viewed as daily activities on the ground that no patient normally leaves hospital without taking some medicine along with him or her. Though HR, finance and marketing are not regarded part of hospital operations management on grounds of their being not as frequent activity as hospital outpatient or inpatient services but there can counter arguments to consider them as belonging to hospital operations management. While defining boundaries for hospital operations management, some professionals argue to keep HR or finance within its scope, on simple reasoning that no hospital activity can be carried out without involving hospital staff or financial transactions taking place almost daily. This can be supported on the ground that HR, finance and marketing also make their inadvertent presence almost daily while dealing with issues such as economics of outsourcing diagnostic services or medical staff scheduling. Furthermore, selection of medical, paramedical or support staff cannot be done in isolation, but with active concurrence by hospital operations managers only. Similarly, hospital finance system is concerned with continuous money supply to the hospital operation management system. All major hospital projects are funded by the hospital finance managers based on budgetary estimates prepared by the operation managers. It is a two way process. While hospital finance system ensures return on investment for capital intensive projects, the operation system communicates its funding needs to the finance system for diverse hospital services covered within its broad umbrella (Mital, 2011). Hospital accounting system provides feedback to the operations system on how well it performs with regard to effectiveness, cost, efficiency, productivity, and profitability measures. In many hospitals accounting is also responsible for the data processing function, which interfaces with all hospital functions including hospital operation system, HR, marketing and finance. Similarly, hospital operations management also interfaces with hospital marketing function for eliciting critical information regarding impending elective surgeries, projections of outpatients and inpatients, targeted population’s perception about the quality of hospital’s service delivery, etc. In return, the hospital operation

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management system provides hospital marketing system feedback relating to effectiveness, efficiency, quality and productivity of the hospital service delivery. Mahatma Gandhi always held the view that medical staff should also focus on healing soul rather than being merely concerned with treatment of body. Hipocrates, Father of the Western Medicine (Circa 460 BC-Circa 370 BC) observed (Byme, 2010), “Natural forces within us are the true healers of disease”. According to sports psychologist and famous author, Thomas Tulko (b.1931), “Your emotions affect every cell in your body. Mind and body, mental and physical, are intertwined”. Gandhiji always stressed on efficient management of services, high standards of cleanliness, rendering service with devotion, doing one’s work without mistakes and once detected quickness to admit them and not allow them to recur, taking self care for maintaining health, etc. all of which are highly relevant for management of hospital services. The paper envisions creation of an ‘enlightened hospital’ that works with service motive and ‘not-for-profit’ objective. The paper highlights relevance of Gandhian ideals as strategy for hospital operations management particularly and achieving the loftier objective of transformation into ‘enlightened hospital’.

2. Health Scene in India Health services provided by government agencies, which can be accessed free or for a nominal free, are grossly inadequate in India. The private sector brings with it bed capacity, skilled human resources and some degree of efficiency. However, even with private healthcare that is a problem that good quality healthcare is not available even in private sector particularly in rural and other remote parts of the country. Private practitioners are hesitant to reach rural areas and hence end up catering to only a small section of the population. In rural areas, private sector accounts for 58 per cent of all hospitals, beds (29 per cent), doctors (81 per cent), and outpatient cases (77 per cent). The corresponding figure for the urban areas is 80 per cent. Both public and private sectors need coordinate their investments and growth in the health sector for larger public interest (Sinha, 2011). Years of prolonged under funding of the public health system and dependence on the private sector has pushed the cost of healthcare, and has also affected access. There is more than Rs. 3,000 expenditure in government hospitals in rural areas during every hospitalization, which is met out of pocket. The out-of-pocket expenditure in the urban areas and in private hospitals is two to three times higher. Public spending on health was 0.94 per cent of the gross domestic product (GDP) in 2004-05, which was among the lowest in the world. Private expenditure on health in India is about 78 per cent as compared to 14 per cent in the Maldives, 29 per cent in Bhutan, 53 per cent in Sri Lanka, 31 per cent in Thailand and 61 per cent in China. GOI now plans to increase its allocation for health to 2-3 per cent of its GDP during the Twelfth Plan (2012-2017) (Sinha, 2011). National Rural Health Mission (NRHM) is by far most important strategic healthcare management initiative in India. NRHM unifies several rural health schemes promoted by the Ministry of Health and Family Welfare (GOI). NRHM aims to improve sanitation, hygiene, safe drinking water, and nutrition levels through the network of primary health centers (PHCs), community health centers (CHCs) and district hospitals. This is important considering that healthcare has direct linkage with several areas such as safe drinking water supply, nutrition, sanitation, female literacy, and women empowerment. This national programme aims to improve access of quality healthcare to poor by ensuring availability of improved clinical technology in rural hospitals, drugs at low cost for common ailments, timely immunization of newly born babies, and adequate health infrastructure and nutritional security for individuals in place (The Times of India, March 10, 2010). Around 30 per cent in rural India did not go for any treatment for financial constraints in 2004 – up from 15 per cent in 1995. Similarly, in urban areas, 20 per cent of ailments were untreated for monetary problems in 2004 – up from 10 per cent in 1995. Loans and sale of assets helped in financing 47 per cent and 31 per cent of hospital admissions in rural and urban areas, respectively. Between 1986 and 2004, the average expenditure per hospital admission increased three times in government and private hospitals. The sharp rise in prices of drugs has been the main reasons for the growing cost of medical care, which more than tripled between 1993-94 and 2006-07. GOI plans to train 22,000 nurses annually. Acute shortage of trained medical manpower is a major problem. GOI envisages availability of 50,000 MBBS seats (as against 35,250 seats currently available) and 25,000 post-graduate seats (as against 20,000 at present) within the next three years (Sinha, 2011).

3. Hospital Operations Management and Gandhian Ideals Enhancing effectiveness, efficiency, productivity and quality of medical services is most important objective of hospital operations management. As healthcare costs are significantly rising over the years analyzing quality productivity becomes critical for hospital operations management (Prahalad, 1999). However, productivity which is the ratio of output to input is difficult to analyze in the context of hospital operations management. It is difficult to determine the output of medical staff and estimation of cost data as many hospitals still do not have appropriate systems in place to analyze cost variations. In hospital systems, inputs such as equipment, supplies, facilities, manpower, etc are all tangibles, while the medical service it delivers is intangible (Jordon, 1994).

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According to Gandhiji, “for administration to be efficient, it must always be in the hands of the fittest. There should be certainly no favouritism” (Young India, May 29, 1924). Service with Devotion A hospital is essentially a service provider and its staff therefore has a pious duty to serve others. Medical staff should always derive pleasure in their service remembering that “life spent in service is the only fruitful life’ (Bapu-ke-Ashirwad, September 16, 1946). Medical staff should work with sincerity and devotion to their best of ability. Gandhiji once said, “Work done sincerely and in the spirit of service will have its effect on all in the long run, and will most assuredly help those who are badly in need of assistance.” (Harijan: Nov 28, 1936). On a separate occasion, Father of the Nation explained that a service provider such as hospital should work with a spirit to provide service to people but not to be served by them. It will not be incongruous to recall what he said in this regard, “Let us not forget that organizations are meant for the service of the people, and not the people for the service of the organizations” (Young India, August 18, 1927). In running any business entity including hospitals people with commitment and sense of devotion are needed as without them no organization can survive for long. It will be apt to remember what Gandhiji often said, “I know no organization that has died for want of funds. Organizations die always for want of men i.e. honesty, efficiency and self-sacrifice” (Young India, June 3, 1926). The religion of a doctor is no other but continuous service of patients which alone justifies the existence of hospital and resulting peace and joy that it would bring to the medical staff. Gandhiji said, “As we cannot live without activity of some sort, there can be only one right channel along which it should flow and that is the service of others. The man, who engages himself in it, can experience supreme peace” (Desai, 1968, p. 268). Medical Expertise A British National Health System Survey in 2009 reported that 15 per cent of its patients were misdiagnosed, while an American study published in the Journal of the American Medical Association in 2000 reported that there were 2,000 deaths every year from unnecessary surgery, 7,000 deaths from medication errors in hospitals; 20,000 from other errors in hospitals; 80,000 from infections in hospitals; and 106,000 deaths every year from non-error, adverse effects of medications. In all every year there occur 225,000 deaths in the US due to unintentional medical errors (Iyer, 2011). According to Gandhiji, “The quickest remedies are always fraught with the greatest danger and require the utmost skill in handling them,” (Gandhi, 1934, p.615). Variability in diagnosis often raises doubts on medical expertise available in a hospital. Gandhiji’s viewpoints are very pertinent in this regard “Remedies vary with the variation in diagnosis. The same physician one day detects malaria and gives a large dose of quinine, detects typhoid the next day and stops all medicine and orders careful nursing and fasting, later detects consumption and orders change and solid food. Is the physician capricious or cautious and honest?” (Gandhi, 1934, p.682). It is common knowledge that anyone can commit errors and hospital staff is no exception. However, whenever a medical or paramedical staff commits a mistake, there should be frank admission with resolve to minimize its occurrences in future. According to Gandhiji, “it is best to own the error. It is sure to add to our strength. Error ceases to be error when it is corrected” (Young India, March 2, 1940). He further elaborated by adding, “The only fitting penance for a lapse is to make a firm resolve not to allow it to happen again. You will thereby build, as it were; a solid wall of protection round you and gradually temptations will cease to assail you” (Young India, January 10, 1929). He further explained, “I have always held that it is only when one sees one’s own mistakes with a convex lens and does just the reverse in the case of others, that one is able to arrive at a just relative estimate of the two” (Young India, November 29, 1928). Reputation of a hospital depends upon the expertise of its medical and paramedical staff and their attitude towards patients. When staff works with devotion and hospital has also necessary equipment and facilities, its reputation is bound to go up. It will be apt to recall Gandhiji’s famous quote in this regard, “Whoever has a desire to render service will certainly try to equip himself with the requisite knowledge, and his knowledge will be an ornament to himself as well as to society” (Gandhi, 1952, p. 84). He further elaborated by saying that “Real knowledge and true education can be had by devoted performance of one’s duty” (Gandhi, 1952, p. 107). According to Gandhiji, “Organizations like men, if they are to command respect and grow, must have a sense of honour and must fulfill their promise” (Young India, January 23, 1930). Timely Medical Aid In hospitals time is the essence i.e. if the precious moment to save a patient of medical emergency is lost the human life is at risk. Chances of recovery would be high when timely medical relief is provided. That is why Gandhiji also maintained, “An organization weakens if its members continuously seek indulgence. I know that procrastination among members is the bane of most institutions” (Young India, August 8, 1929). In a hospital, there is no room for rest any moment for medical staff as medical emergencies do not follow any time schedule. Hospitals need continuous activity and service all the time. Bapu’s words are very apt in this

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regard, “God is continuously in action without resting for a single moment. If we would serve him or become one with him, our activity must be unwearied as his.” (Gandhi, 1932, p. 47). Quality Medical Care In healthcare there is no room for any sub-standard medicine used or a poor quality health service provided. All medical staff should give their very best in terms of what could be called a true quality service i.e. making correct diagnosis, using medicines which are best suited and that are within their perishable life, attending patients on time, maintaining proper hygiene and cleanliness, attending medical emergencies on priority, etc. In this regard it will be appropriate to recall what Gandhiji said, “I attach the highest importance to quality, irrespective almost of quantity … I plead for quality and quality alone” (Young India, April 30, 1925). At another occasion Gandhiji also added that God is pleased with quality work and not quantity when he said, “It is the quality of our work which will please God and not quantity” (Gandhi, 1934). In hospitals there is no room for any substandard work where human lives are at stake. It will be appropriate to recall what Gandhiji once said: “Slipshod work is like half-baked bread, fit only to be thrown away.” (Bapu ke Ashirwad, May 9, 1945). If medical and paramedical staff performs their duties in best possible manner their reputation is bound to go up. “Good work spreads like the perfume of a rose.” (Gandhi, 1961, p. 107). Harmony in Medical Teams Hospital activities are interdependent. An operation cannot be carried out unless an anesthetist first administers anesthesia. Nobel Prize-winning physicist Albert Einstein (1879-1955) once said (Byme, 2010), “A hundred times every day I remind myself that my inner and outer life depend on the labours of other men, living and dead, and that I must exert myself in order to give in the same measure as I have received and am still receiving.” Thus, cooperation from others is vital for human existence and any task we accomplish. There are situations, when some persons in a team might offend someone. For the success of the work on hand to which team members are committed, it becomes necessary to maintain interpersonal harmony. It will be most apt to remember what Rene Descartes (1596-1650), ancient mathematician and philosopher, advised (Byme, 2010), “Whenever anyone has offended me, I try to my soul so high that the offense cannot reach it”. Gautam Buddha always highlighted power of positivity in life, who advised (Byme, 2010), “If a man speaks or acts with an evil thought, pain follows him. If a man speaks or acts with a pure thought, happiness follows him, like a shadow that never leaves him”. Similar views were expressed by the Chinese philosopher, Mozi, who visualized group harmony (Byme, 2010), as when “When all the people in the world love one another, then the strong will not overpower the weak, the many will not oppress the few, the wealthy will not mock the poor, the honoured will not disdain the humble, and the cunning will not deceive the simple”. As a related example in hospital services, for the success of surgical operation harmonious relationship between anesthetist and doctors is very essential. A quote by Gandhiji shall be apt to highlight the point, “No organization can run smoothly when it is divided into camps, each growling at the other and each determined to have its own way by hook or by crook” (Young India, November 9, 1929). Service and love are helpful in building harmony in work teams. This is also reflected in Bapu’s such views, “Real affection is not shown through praise, but through service” (Young India, March 14, 1929). Hospital Communications Communication is a process by which a leader or a manager transfers and receives information in managing business. In fact, communication is the nervous system of a hospital. Communication processes within a hospital are vital for achieving healthcare goals. They are the processes that link different departments – outpatient services, inpatient services, emergency services and laboratory services, and other hospital functions, which are relevant at all levels, connecting all hospital staff in some capacity or the other. The effectiveness of the communication system – the way in which it is managed – has a significant impact on the ultimate effectiveness of the hospital. Information is power which is conducive for problem solving, decision making, change management, and building trust and relationship. In a hospital typically a message from the chief medical officer or medical superintendent may be a directive to complete a pending surgery on priority; it may be an advice to perform a medical procedure in different manner to suit patient conditions; it may be an approval or disapproval of the hospital expansion proposal submitted; it may be new hospital policy to be in force, or a feedback about the hospital performance from the community. In hospitals medical staff deal with superiors, equals and subordinates at regular intervals through verbal and written communication, involving horizontal and vertical communication. Horizontal communication is as important as vertical communication in hospital systems. In hospitals unless communication is essential for clinical reasons, silence is otherwise rewarding as patients heal more in silence than in noise. Gandhiji observed, “My experience tells me that silence soothes nerves in a manner no drug can. With me, it also induces sleep. To produce the effect I have described, silence has to be

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liked. No one, however, need be silent out of love of imitation, or merely for the knowledge that it produces on me the effect described by me.” (The Health Guide, p.197). Hospitals should maintain utmost calm. In hospitals, these noises are simply maddening. They are made in total disregard of the feelings of other patients. Many patients and their relatives indulge in loud talks which they can easily carry on in gentle tones. Gandhiji once said, “I have often tolerated maddening noises which could have been easily avoided. I am well aware that they are injurious to health” (The Health Guide, p 192). Hospital Productivity Resourceful hospital managers are capable of improving productivity even with the severe budget cuts, which results in doing more with the same or fewer resources. Hospital administration should be in constant touch with its staff as it is only they who can provide clue for developing creative and innovative solutions that my drive hospital productivity as it lies in the minds of those who are closest to the work. According to Gandhiji, in any performance measurement exercise it is the results achieved that counts. He noted, “It is our actions which count. Thoughts, however goods, in themselves, are like false pearls unless they are translated into action.” (Collected Works of Mahatma Gandhi, Vol. LI, p. 41). He further elaborated by saying that “in the Divine account books only our actions are noted, not what we have read or what we have spoken” (Gandhi, 1934, p.122). Medical emergencies are common feature of a hospital which sometimes gives rise to panic. However, it is important to avoid panic as it has adverse impact on hospital productivity. Bapu was believer in God and he held that everything, good or bad, occurs in this world with His concurrence only. In hospital environment it is absolutely important that “panic must be avoided at all costs. We must refuse to die before death actually takes toll” (Harijan, Feb 17, 1946). According to Gandhiji, “The nectar of Ramanama imparts joy to the soul and rids the body of its ailments” (Bapu-ke-Ashirwad, July 9, 1946).

4. Cleanliness and Hospital Waste Management Hospital should maintain surroundings very clean and no waste should leave hospital complex without first undergoing incineration. This is important in order to keep hospital environment free from infections. The reason is obvious that a hospital is visited by patients of all sorts and from any area, and hence chances of infections being spread are enormous when cleanliness levels are low. Hospital waste management has emerged as a distinct branch of hospital administration and in India there exists an independent professional society that addresses wide range of subjects relating to hospital waste management. Gandhiji did not specifically write on hospital waste management but his numerous short communications covering varied issues of cleanliness which as already stated carry high relevance in hospital context. Cleanliness is important in any organization but its need is much more overriding in hospitals than anywhere else. It will be very appropriate to reproduce one of his quotes on cleanliness which makes perfect sense in the hospital context. “A meticulous sense of cleanliness, not only personal but also in regard to one’s surroundings, is the alpha and omega of corporate life” (Harjijan, June 16, 1946). Mahatma Gandhi was always against throwing wastes outside as for him societal concerns were always uppermost in his mind. He observed, “We do believe in removing dirt from our rooms, but we also believe in throwing it in the street without regard to the well-being of society. We are clean as individuals, but not as members of the society of the nation of which the individual is but a tiny part” (Young India, April 25, 1929). He further added towards later part of his life, “Our personal cleanliness counts for little if our neighbours are not clean” (Bapu-ke-Ashirwad, June 1, 1946).

5. Medical Ethics and Hospital Operations Management A hospital is a service provider which is visited in moments of distress and not by one’s choice and thus it is unethical to cash on patients’ crisis moments. Furthermore, when an organization is over flowing with money it may generate by earning illegitimate profits and losing its ethical behaviour or spiritual conduct in the process. This is because when a corporate hospital generates surplus funds at its disposal it may slip into money centric behaviour losing faith in God. A quote of Mahatma Gandhi very aptly explains this process, “I have always felt that when a religion organization has more money than it requires, it is in peril of losing its faith in God and pinning its faith on money… The fact is the moment financial stability is assured, spiritual bankruptcy is also assured” (Harijan, December 10, 1938). According to Father of the Nation (Gandhi, 1922), ‘The science of Ethics is still in its rudimentary stage. Men have been interested so far in the investigation of the phenomena of the external world. We have not had till now any fearless explorers into the moral world. The true laws of morality can be ascertained and systematized only when men are prepared to devote themselves to their investigation with the same disinterested zeal as in the case of the positive sciences.”

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Hospital authorities should always try to run hospital as a ‘not-for-profit’ organization except when it becomes very necessary to earn some legitimate profits for maintaining the standards of hospital services. A private hospital can charge some nominal profits on its operations only when it needs money to make further investments on medical technology. While there can be some debate on degree of profitability hospitals should work at there can be absolutely no reason for overcharging hospital fees or indulging in violations of medical ethics. A hospital without medical ethics is a hospital at risk. According to Gandhiji, “it is wrong to think that business is incompatible with ethics. I know that it is perfectly possible to carry on one’s business profitably, and yet honestly and truthfully” (Harijan, May 4, 1935). According to him, honesty is the best policy in such matters. He noted, “It is difficult but not impossible to conduct strictly honest business. The fact is that the honester a business, the more successful it is. Hence, the proverb coined by businessman: ‘Honesty is the best policy’” (Harijan, July 28, 1946). Gandhiji was always supporter of good moral conduct and ethical behaviour in every sphere of human endeavour. It is my firm conviction that all good action is bound to bear fruit in the end (Young India, June 2, 1927). Man is what his actions make him. He rises by good actions, and falls by evil ones (Bapu-ke-Ashirvad, March 10, 1945). Individual experience is not the only factor in an action. Faith and imagination do play their part (Speeches and Writings of Mahatma Gandhi, p.512). What the world needs is not words, but action. Actions and thoughts tell far more than speech (Harijan, Sept. 29, 1946). However lofty the ambition, it should embrace within its ambit even those considered the lowliest of creatures (Bapu-ke-Ashirvad, Sep 11, 1946).

6. Enlightened Hospitals and Gandhian Ideals A hospital run on ethical lines is essentially an enlightened organization. In an enlightened hospital a leader has a role in inspiring medical teams with his vision, positive outlook and optimism. Flexibility is a key for transforming a hospital into in enlightened hospital which largely follows from individual initiatives under a dynamic leader and a supportive hospital culture. An enlightened leader, such as chief medical officer or medical superintendent, can achieve competitive advantage by succeeding to secure commitment of medical and paramedical staff for giving quality output and excellence. An enlightened leader can succeed to retain committed employees in the hospital even though they may not be best in terms of perks and other facilities offered by other private corporate hospitals. Mahatma Gandhi was a combination of opposites, outer softness and inner toughness. While ends of any worthwhile pursuit should remain unchanged but flexibility can be exercised in choice of means but with an associated rider that these have to be always fair and ethical. This notion is implicit when Gandhiji said, “A person or an institution should be like a strong tree, with very strong roots, but with flexible branches. This is because the real test of the strength of a person or institution is during a storm. And when the winds blow very fast, the strong roots are required to keep the tree firmly embedded in the ground. But at the same time, the branches have to be flexible, so that they sway with the wind and don’t break” (Kochhar, 2010). An enlightened hospital is also flexibility driven as far as possible. Softness and resilience are desirable traits in human interaction, which are manifestations of flexible behaviour. Gandhiji’s belief in such human characteristics are obvious when he obseved, “It seems to be that people, who admit they are wrong, go a lot further than people who prove they are right”. Connotation of flexibility is also implicit in this Gandhian thought when he noted, “Action must vary with every varying circumstance. It is not inconsistent, if it springs from the same source” (Young India, September 11, 1924). According to Gandhiji, “Adaptability is not imitation. It means power of resistance and assimilation” (Young India, Oct 7, 1926). In enlightened hospital, a doctor should definitely be above any notion of temporary loss or gain. Viewing setbacks as change, not loss or failure is common perception in an enlightened hospital. As he works with a sense of commitment and service to the hospital temporary setbacks do not affect him from giving his best. A leader sets benchmark for high performance and excellence for others to emulate. This is with this type of leadership that chances for survival of corporate hospital become more assured in the long run. A sense of duty towards patients in spirit of service should be the supreme motto of a doctor. A doctor who learns to look at every patient in the spirit of service finds no work low or uninteresting. “He will see God in any work which comes to his share, and feels that he was serving him through it. His interest in work does not depend on the nature or type of the work. It springs from within, from his sense of devotion to duty.” (Collected Works of Mahatma Gandhi, Vol. LI, p 44). Work of a paramedical staff who bandages patients in queue one after another may become irksome or annoying but anyway the job is to be done joyfully otherwise one may faulter in delivery. Gandhiji said, “One should do the task on hand without expecting pleasure from doing it, do it merely as one’s duty. He who approaches his work in this spirit, who desires nothing through it, will not have to suffer the effects of Karma” (Harijan, August 19, 1939).

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7. Self Care as Best Medical Remedy Mahatma Gandhi was among one of the greatest champions of good health, and according to him ideally hospitals should not exist at all except for medical emergencies, care of the aged, care of the terminally sick, etc. It will be pertinent to recall Gandhiji’s views in this regard. Their growing number is an indicator that individuals don’t keep themselves physically fit. It will be apt to read what Gandhiji said in this regard, “Hospitals are the instruments that the Devil has been using for his own purpose, in order to keep his hold on his kingdom. They perpetuate vice, misery and degradation and real slavery” (Gandhi, 1934, p. 1042). Gandhiji further said, “I believe that a multiplicity of hospitals is no test of civilization. It is rather a symptom of decay” (Gandhi, 1965). He added, “We want healers of souls rather than bodies. The multiplicity of hospitals and medical men is no sign of true civilization. The less we and others pamper our bodies, the better for us and the world” (Young India, September 29, 1927). However, such an ideal can be realized when everyone is careful about his health. While it is responsibility of the medical staff to look after a patient but latter has also to observe certain norms. No one can ignore his health, “A patient can ill afford to conceal his disease. If he does so, be becomes his own enemy” (Gandhi, 1928). This apart, Gandhiji also noted, “A patient has to eat, sleep, complain and bully. He is an angel when he omits to do the two last things” (Desai, 1932). Mahatma Gandhi always believed that health is the real wealth which an individual can possess as many rich people may feel pauper when they are poor in health as money may not buy good health. Mahatma Gandhi on June 29, 1935 in Harijan wrote: “It is health which is real wealth, not pieces of silver and gold.” According to him, “Only that man can said to be really healthy, who has sound mind in a sound body. The relation between the body and the mind is so intimate that if either of them get out of order, the whole system would suffer” (Gandhi, 1923, p.16). “No man whose character is not pure can be said to be really healthy. The body which contains a diseased mind can never be anything but diseased” (Gandhi, 1923, p.16). Maintaining good health is important from several angles including one that it is God’s gift to us which is to be used for service of others. Gandhiji noted “The body does not belong to us. While it lasts, we must use it as a trust handed over to our charge” (Gandhi, 1932, p.13). He added, “So long as we wear this vesture of clay, let us keep it clean, pure and healthy; and when we have to cast it off, let us discard without any regret. It was given to us for use. Let the Giver take it away when He pleases. We have to use it for service only, and not for enjoyment” (Desai, 1932, p.276). We should have fairly good knowledge whatever body requires and avoid dissipating our vital energies. He wrote, “And yet about nothing are we so woefully negligent or ignorant as in regard to our bodies. Instead of using the body as a temple of God, we use it as a vehicle for indulgences, and are not ashamed to run to medical men for help in our effort to increase them and abuse the earthly tabernacle” (Young India, August 8, 1929).

8. Concluding Remarks India needs large number of small hospitals in rural areas that offer low cost quality healthcare. Affordable healthcare is not entirely new to the private sector. Deviprasad Shetty’s heart hospital Narayana Hrudayalaya and charitable eye hospitals ‘Sankara Nethralaya’ and ‘LV Prasad’ offer high-quality, affordable healthcare. Doctors are paid competitively; there is investment in t raining of auziliary staff; there are hospital information technology systems to keep track of patients and clinical outcomes; and patient feedback is actively sought in many upcoming low-cost hospitals in rural areas (Kamath, 2011). According to Bapu, “I believe that a healthy soul should inhabit a healthy body. To the extent, therefore, that the soul grows into health and freedom from passion, to that extent the body also grows into that state.” (Young India, June 5, 1924). It is with God’s grace that we are into this particular body and accordingly it becomes obligatory that we keep it healthy and fit to serve humanity. Gandhiji added, “There is an incessant struggle going on within us between our Soul and Satan for the control of our body. If the Soul gains the ascendancy, the body becomes a most potent instrument of good; but if the Devil is victorious in the struggle, it becomes a hot bed of the vice” (The Health Guide, p.19). Gandhiji observed, “Man came into the world in order to pay off the debt owed by him to it, that is to say, in order to serve God and (or through) His creation. Keeping this point of view in front of him, man acts as a guardian of his body. It becomes his duty to take such care of his body as to enable it to practice the ideal of service to the best of ability”. (The Health Guide, p.24). All that is given cheerfully and generously to another comes back to you and enriches your life in unexpected way. Gandhiji always believed that body needs to be maintained properly, among others, in order to serve society and mankind. He wrote, “Our body has been given to us on the understanding that we should render devoted service to God with its aid. It is our duty to keep it pure and unstained from within as well as from without, so as to render it back to the Giver, when the time comes for it, in the state of purity in which we got it” (The Health Guide, p.17).

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According to Gandhiji, “The body can be of real service only when we realize it to be a Temple of God and make use of it for God’s worship; otherwise it is no better than a filthy vessel of bones, flesh and blood, and the air and water issuing from it is worse than poison. It is not most disgraceful that for the sake of this body, we should stoop to falsehood and deceit licentious practices and even worse?” (The Health Guide, p.18). Numerous are our ailments; numerous, too, are physicians and their treatments. But we would be spared much bother if we regarded all diseases as one, and Rama (God) as the one and only Physician who can eradicate them (Bapu-ke-Ashirwad, Dec 29, 1944). Gandhiji also said, “It is well that it (body) lasts whilst there is use for it. It is equally well that it perishes when there is no use for it. And since we don’t know when it will outlast its use, we conclude that death through whatever cause means that there was no longer any use for it” (Bapu’s Letter to Mira, p.210). At another occasion Gandhiji noted, “Though death and life are the faces of the same coin and though we should die as cheerfully as we live, it is necessary while there is life to give the body its due. It is a charge given to us by God. And we have to take all reasonable care about it” (Desai, 1932, p.124). Gandhiji had supreme faith in the Almighty as it is He who oversees all activities in this world. He once observed that ‘when death extends its icy hands not the greatest medical power available on earth can save the person from the jaws of death’.

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York. 2. Desai, Mahadev (1932), “The Diary of Mahadev Desai”, Navajivan Trust, Ahmedabad. 3. Desai, Mahadev (1968), “Day-to-Day With Gandhi-I”, Sarva Seva Sangh Prakashan, Varanasi. 4. Gandhi, M.K. (1922), “Ethical Religion”, Pub. S. Ganesan, Madras. 5. Gandhi, M.K. (1932), “From Yeravda Mandir”, Navajivan Trust, Ahmedabad. 6. Gandhi, M.K. (1934), “Speeches and Writings of Mahatma Gandhi”, Pub. G. A. Natesan, Madras. 7. Gandhi, M.K. (1952), “To Ashram Sisters”, Navajivan Trust, Ahmedabad. 8. Gandhi, M.K. (1961), “Letters to Rajkumari Amrit Kaur”, Navajivan Trust, Ahmedabad. 9. Gandhi, M.K. (1965), “The Health Guide”, Pub. Anand T. Hingorani, Allahabad. 10. Gandhi, M.K. (1969), “Bapu-ke-Ashirvad”, Pub. Anand T. Hingorani, Allahabad. 11. Gandhi, M.K. (1969), “The Collected Works of Mahatma Gandhi”, Publications Division, Patiala

House, New Delhi. 12. Iyer, Malathy (2011), “Medical Errors in Top Ten Killers: WHO”, The Times of India, April 20, 2011,

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17. Prahalad, C.K. and Krishnan, M.S. (1999), “The Meaning of Quality in the Information Age, Harvard Business Review”, Sept.-Oct., pp.109-118.

18. Rao, T.V. (2010), “Managers Who Make a Difference Sharpening Your Management Skills”, The IIM Ahmedabad Business Book Series, Random House Publishers India Private Limited, Noida 201301.

19. Singh, D. (1995), “Effective Managerial Leadership”, Deep & Deep Publications, F-159, Rajouri Garden, New Delhi 110027.

20. Sinha, Kounteya (2011), “Health Budget may Go Up by 2 per cent”, Times of India, May 8, 2011.