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1.    IntroductionHealth spring is a social enterprise,pioneer, and leader in organized primary health care community medical centers inIndia. Started by Dr. Gautam Sen (Chairman and Founder) along with his sonKaushik Sen (Co-founder & CEO) in 2010. Healthspring’s foundation was theresult of the realization that the primary healthcare delivery sector in Indiais broken and needs immediate attention as it is the most critical part ofhealthcare delivery being the entry level of care. Currently they are disruptingconventional primary healthcare delivery in India and creating a culture ofgood health.

1.1  The outreach model toall sectors of the societyHealthspring believes thateffective primary and preventive care can only be delivered by providingtailormade solutions to address the needs of diverse groups.Offerings:a)       One roof solution for an individualand familiesb)      One roof solution for communities,corporates houses, industrial complexes, multiple health packages, a variety ofinsurance schemes to cater to a diverse population (Figure 1 and 2).2.

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    Infrastructure,Coverage and Management Team2.1  PhysicalInfrastructure·      30 clinicsacross India·      Aspiresto have 150 clinics in future·      100doctors and 500 other health experts·      Served350,000 patients, 150 corporate clients, 100000 health check-ups and handled closeto 2000 emergencies2.2  Management TeamHealthspring’smanagement team is highly decorated and technically very strong where founderand co-founder have a strong background in clinical healthcare and healthcaremanagement along with multiple affiliations with national and international healthcareorganizations (Appendix- Figure 3) (Source: www.healthspring.in). 3.    Theories ofOrganization Culture and Ideological Currency3.

1.  Schein’s Model of CultureLet us discuss direct and indirect cues of Healthspring’sorganization culture through Edgar Schein’s organization culture modelalso popularly known as the Onion model.                                Source:www.toolshero.com3.1.1.     Artefacts and Symbols:These are observable facts about the organization thatemployees can see.

ARTIFACTS & SYMBOLS Visible Cues Stories Jargons   Rituals Management Practices Norms Logo: Red cross mark and green leaves suggestive of call for Healthy India Source: www.Healthspring.in   Client Testimonials: Praises for  Healthspring   Jargons used on the website: ‘Pioneers in Primary Health care’ No mention of any regular organization specific events on the website.

Hierarchy: Power structure of the organization is very hierarchical, formal and mechanistic.   Tasks, roles, and responsibilities are clearly defined. Quality and value-based primary healthcare which meets a specific individual’s requirement.

Website: Call to Action – Very well organized and intuitive website in terms of use of icons, symbols etc. Use of images which are very subtle, close to common man’s imagination and promising. Blog: ‘Emergency assistance program’, ‘Difference between life and death- the golden hour’, ‘U.S. steps up as loan guarantor for expanding India’s primary healthcare network’. ‘You are a patient second, person first’ No mention of employee award system on website Shared Values: ‘Delivery top-quality primary health care’. No compromise of the quality and standard of care.   This is also suggested by the mission, vision statement, and Jargons used on the website.

Facts: Success facts in terms of number of patients served, number of emergencies handled, number of clinics etc. Success stories: ‘Mr. Kaushik Sen India’s top 40 Business Leaders in 2017’, ‘Healthspring wins “Best Building of a Brand” Award at HBI Business Model Innovation Global Award – 2017’ ‘You can never be prepared for emergency, your doctor ought to be’   Executive body – has the decision-making authority which is comprised of extremely competent board members.   Mission: Correct the broken health delivery system in India Stories like ‘Get Fitness 360’, ‘Health benefits of Flax seeds’. ‘Ready access to family physician is your right’   Clearly defined responsibilities in terms of designation and role   Vision: Achieve excellence in healthcare delivery through best of knowledge and skills, provide people focused, transparent, ethical care and 24*7 care   ‘You should have your questions met with answers and not just prescriptions’       Service offerings on website: Customised service packages for all needs pertaining to primary health care           Physical Arrangement: Formal dressing, one cafeteria, separate role specific sitting based on status and function           Source: www.

Healthspring.in, DirectObservation     Interpretation of Artefacts and Symbols:·       Visible Cues Advantages/Positives Disadvantages/Negatives Formal organization with a sharp focus on healthcare delivery and quality (Martin, 2002) Stress to perform and deliver high quality care Facts, figures, vision and mission statements, display of awards is symbolically reflective of organization’s good performance (Meyer and Rowan, 1977) High stress on performance can lead to employee stress The physical arrangements in the office can interpret a great deal of organization ethos (Tom, 1986). Healthspring has a very role specific sitting Less communication, less flexibility Formal dressing is suggestive of high focus on image, professionalism, sincerity towards their work Less communication, less flexibility, more work stress                    Healthspring workspace-  Source: https://www.practo.com ·       Stories Advantage Disadvantage Suggestive of a sense of pride and achievement in what they do Performance stress Visible cues to gain credibility and attention among customers Performance stress  ·       Jargons Advantage Disadvantage Strong statements about promising the best quality primary care suggests strong focus on quality primary healthcare delivery Performance stress, work stress  ·       Rituals: No mention of any public or internal organization specificevents on the website hence suggestive of not so strong focus on employeeengagement and employee wellbeing. ·       Management Practices Advantage Disadvantage A hierarchical, formal and mechanistic organization with strong focus on quality is suggestive of a strong operational, goal-oriented focus, clear chain of command and specialization No flexibility, poor communication, disunity  ·       Norms Advantage Disadvantage Suggestive of high focus and motivation on quality of care (Vroom, 1964) Suggestive of high-performance pressure to achieve  3.

1.2.        Espoused Values·      Uncompromised QualityPrimary Healthcare – Patient First: The mission and vision of Healthspring are to provide the bestquality primary healthcare through medical excellence and customized healthcareofferings to bridge the gap in existing healthcare delivery. Dr.

Senhighlighted the issue of ‘more emphasis on secondary and tertiary care’ and ahuge neglect towards primary care’ and further said this is the main cause ofpoor health outcomes in India. (Interview with Healthcare Executive, 2016). ·      The expansion plan tocreate a major impact in healthcare delivery: Healthspring wants to make sure quality care reaches themajority of the Indian and hence to create impact they have plans for pan-Indiaexpansion (up to 150 clinics from today’s 30 clinics) (Business Line, 2013).

·      Affordable, available,accessible care- Empathy: Thefounder Dr. Sen spoke about a big vacuum in healthcare delivery for consumers. Dr.Sen said – “Consumers need someone to take care of themselves, treat themfairly, give them good consistent care, with basic facilities under one roof,and for higher level things they don’t need on a routine basis to send them tosomeone who will treat them well” (Moneylife, 2011). He emphasized on the cost-effectivenessof the healthcare provided and importance of havingtrusted family doctors (the culture which has died in India) to make the careaffordable and accessible (Interview with Healthcare Executive, 2016).

 3.1.3.     Assumptions                             The underlying assumptions which are self-evidentare:·      Quality: Healthcare delivery and services should be of top quality ashuman life cannot be compromised. ·      All primary care ailmentswill be taken care of.·      Customized: Should provide customized healthcare which is need-based.

·      Cost-effective care: High ethical and moral standards of health care delivery. 3.2.  Kotter’s Theory of Organization CultureThe way Healthspring has brought about change in primaryhealthcare delivery can be explained well using Kotter’s change modelfor organization culture:·      Create Urgency: There are only has 1 million allopathic doctors to treat apopulation of 1.3 billion population in India (Hindustan Times, 2017).

Self-styleddoctors without formal training provide up to 75% of primary care visits. Lackof quality primary health care services leads to poor health outcomes (WHO,2017). Hence Healthspring leadership spoke on various platforms about urgentattention to address this gap in quality of primary health care and reinforcingthe need for one-stop shop for comprehensive primary care under a single roofas well as person-focused care rather than disease-focused (Appendix – figure 4).Dr. Sen spoke about strengthening primary care in the public sector and missingin the Indian private sector. He called for policy reforms for strengtheningthe primary care. He is currently an advisor on the central governmentcommittee for strengthening Primary care delivery in India (Interview withHealthcare Executive, 2016).

     Source: www.hindustantimes.com·      Form a powerfulcoalition: The founder andco-founder formed a team of relevant experts and doctors who had accomplishedsuccess in their respective roles and had a common interest in transforming theprimary care delivery from what it was. (Appendix – Figure 3)·      Create a vision forchange: Defined roles with allworking towards bridging the gap in primary healthcare delivery by providing aone-roof solution to suit specific individual/community/group need.

·      Communicate the vision: Founders continuously voiced their vision at multiple social,national and international platforms. Their web page itself showcases blogs,stories and award stories putting emphasis on top class primary care (Interviewwith Healthcare Executive, 2016).·       Remove Obstacles: Healthspring did a huge marketing campaign to generate theawareness on the need of having specialized quality primary care under one roofas this idea in 2010 was disruptive. They got into partnership with ‘Associationfor Trauma Care in India’ to facilitation the process of coming up withmultiple primary care clinics (Source: www.healthspring.in).

·      Create short-term wins: Just in a span of 7 years from inception, they managed to350,000 customers, 2000 emergencies and 100,000 health checks! They havemanaged to open 30 primary care clinics and further intend to expand up to 150clinics across India.         Award for Dr.Sen, Source: www.

healthspring.in·      Build on the change: Need for expansion was realized to outreach and furtherdiversify to community/group specific solutions. They further went ahead topartner with 150 corporate clients and want to have 150 clinics in future whichthey are working towards. ·      Anchor the change: They are working on further building the team with likemindedpeople to bridge the gap between need and feed (Dauber, Fink & Yolles, 2012).They are planning on collaborating with the Indian government and internationalorganizations to help them achieve their long-term goal.

4.    Theories of Leadership Style4.1.  Burns Theory of Leadership·      Quality Over Profit (Burn, 1978): The challenge in front of Healthspring was to provideprimary healthcare to the larger masses in India, maintain quality as well asbe able to make a profit to further re-invest in growing the numbers of primaryhealthcare clinics across different states in India. Hence it made it all themore important to be profitable to make the vision happen (Wendy K.

Smith, Marya L. Besharov,  Anke K. Wessels, and Michael Chertok, 2016). To achieve so, Healthspring took some strategicsteps like approximately $5.5 dollar/consultation (www.

healthspring.in) whichis very competitive pricing in the Indian market, multiple services under oneroof to capture market better to name a few. Primary Healthcare clinics inIndia is a ‘Disruptive Idea’ and hence there was a huge value proposition forcustomers to get all primary care under one roof! Dr. Sen overcame Juxtapositionof social mission and business outcomes without compromising on quality (Antonakis,John; Day, David, 2017). In his interview with ‘Healthcare Executive 2016’, Dr.Sen emphasized on bringing back top quality healthcare management anddevelopment practices and family medicine practices in Hospitals and clinics.

In2010, Medical Council of India was dissolved on account of corrupt practicesand Dr. Sen was a part of 6 member board created to investigate this matter. Thiswas a result of his top quality, ethical healthcare services to the nation(Interview with Healthcare Executive, 2016).The Allocentric Leader: As per the psychographic matrix of leadership (Burn, 1978), Dr.Sen is allocentric who is highly influences by Indian culture, his educationand general awareness of healthcare scenario in India. In his interview with’Healthcare Executive 2016′, he said he had the strong desire for serving thehealthcare needs of Indians.

Wants (Burn, 1978): Dr. Sen was driven by collectiveexpectation since childhood, social aspirations and political demands totransform healthcare needs of developing India. He voiced out the fact inmultiple instances that primary health care being the first level of care isvery important. The authenticity of the idea, it being disruptive then, lead tothe success of the venture (Gandhi, 1927).

Transmutation of Needs (Burn, 1978):Healthcare scenario in India is not up to the mark in terms of quality andreach. This inspired Dr. Sen to create a setup which could address theshortfalls of health care delivery.Morality- Ideas as moral power (Burn, 1978): Dr.

Sen often said Healthcare is the right and everyone should have access to goodquality care (Interview with mixcloud.com, 2016) (Appendix – Video Link 1)Transformational leader (Burn, 1978): Dr.Sen and his team are trying to deliver affordable and quality healthcare toraise the bar for quality care in India. Dr.

Sen strongly believes that for animpact, the whole team needs to perform at their best to achieve high-qualityoutcomes especially amidst resource constraints (Interview with mixcloud.com,2016).         5.    Key Arguments AroundOrganization Culture and Recommends         6.    Key Argument Around Leadership andRecommends 7.    ConclusionHealthspring has started something which is very disruptive in the Indianmarket and that is Transforming Primary healthcare which was otherwise is notgiven upon due importance.

Through thought leadership and value driven service,Healthspring can make its mark. But more importantly, it needs to work towardsan organizational culture which is motivating the employees towards givingtheir best. As Healthcare industry is very stressful as it deals with humanlives, it very important to create an environment which is conducive to workfor everyone and is stress-free!


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