 This session is on Organization Development in Non-Industrial Settings, why this topic is important? There is a need to understand and study Organization Development in the Non-Industrial setting because quality of human life depends on many non-industrial fields like health care, education, not-for-profit developmental organizations and the social entrepreneurship. The size of non-industrial organization is also increasing with the scale of their work and that is leading to individual team and organizational level issues. Traditional OD, I am saying it traditional because most of the OD interventions we have studied till now were developed in the industrial settings or in the organizations which were commercial organizations. Their frameworks may not be applicable or they may need to be modified in the non-industrial context. So, these are the reasons why we need to study OD specifically in the context of non-industrial setting. In this session we are going to look at three non-industrial settings OD in health care in educational institutions and in developmental organizations. First we will look at OD and the nuances of OD in health care sector. All our discussion is primarily contextualized in the Indian setting. So, when we look at the non-industrial organizations they are not in the global sense because these organizations might be facing different types of issues in the different parts of the world. So, our discussion on the health sector, education sector or in the sectors of social entrepreneurship or not for profit organizations will be based on Indian context, OD in health care. Indian health care sector has been growing very rapidly in last two decades and due to it is happening due to increasing privatization and corporatization of the sector as well. With little more emphasis on the health care by in terms of the government expenditure and different interventions and policy initiatives like Ayushman Bharat health care sector is bound to increase and bound to include more number of people. Many health care organizations fall into the category of rapid growth organizations as such there is a year to year 20 percent growth in the health care sector in India. Major references for this session are drawn from the from these research papers. If we look at the emerging scenario of the health care sector in India we come across few of the key features. These features are privatization of the health care, development of the new business models. We are going to look at few of the business models in this session. Increasing integration of the management systems in health care service delivery. In the health care innovation is not only happening and not only required in terms of the scientific discoveries about the cure of the disease, nature of the disease or instruments being used in the health management but it is also on the service delivery part. So, there is lot of there are lot of innovations happening and on the service delivery part and that is where the integration of the management system with the health care service delivery system is happening to a great extent. There is also a need for infusion of the management tools and methods and here we also include the IT related tools and methods. If we specifically look at the HRN sector, why we need to look at the human resource management issues or HR issues is because OD predominantly draws from the human issues. Though OD includes organization design, processes, systems and we also include digital transformation or the IT related issues in the process of management of change and organization development. OD primarily looks at all the subsystems from the human perspective. So, it is imperative to look at human resource management issues to primarily understand the nuanced nature of field of OD in the health care. What we look at in the newly emerging health care sector in India is that health insurers, third party administrators, medical tourism, pathology labs, they all have emerged just in the last one or one or two decades and they are filling lot of structural gaps in the health care sector. We are also seeing the services like health insurance, diagnostics and they are effectively they are effectively intermediaries towards a more highly integrated health care management system and that health care management system is centered on large hospitals. In light of these factors, the major HR challenges are related to knowledge and skills required for jobs in core health care sector as well as in the sub sectors. Curriculum development in the formal medical education system has somehow not kept pace with the demand for the talent in these sub sectors. Organizations therefore, often need to develop and groom people from within or re-skilling the employees recruited from related industries. One of the examples is that health insurance organizations are very frequently recruiting and retraining the talent from the general insurance sectors. These HR issues are posing unique challenges for OD in hospitals and health care system in general. First unique thing in the hospitals or the health care system is that any other industry with the advent of technology, modernization, computerization demands less human interaction. Whereas, with all the advent of technology, modernization and computerization, newer diagnostic and new intervention technique, the need for an importance of human labor in hospitals have not decreased. In fact, it has increased. The characteristics of the health care context emphasize is still on the ethical practices and promoting caring environment. However, in order to meet the scale and the emerging requirements, there are lot of new systems and processes are being introduced in the health care system. But eventually a system is assessed not on its sophisticated systems and processes, but on the ethical practices and the caring environment it is giving to its customer and its customer is patient to promote and maintain the organization culture that reinforces the values and ethos required for the compassionate health care service delivery is equally important or even more important with the all modernization and the evolution of the field in terms of the technology in the processes. Like other sectors where organization structure is pyramidal, generally we find the pyramidal structure or we also looked at different designs of organization in our previous sessions. There is a very unique organizational structure and design we see in the health care system. So, health care delivery system and if we look at the in particularly in reference of the hospitals, the large multi-speciality hospitals also require one to one or one on one interactions and coordination between employees from various departments. So, in the health care system, there is a very unique cylindrical organization structure is visible. In view of unique features of human resources, management issues and challenges to OD, there can be some very specific interventions very relevant for the health care sector and particularly in the hospitals. We need to recognize that patient care delivery teams at tertiary level often comprise doctors and support staff from different branches of medicine. Let me take example of cardiac care, several personnel from cardiology, cardiac surgery, anesthesia, intensive care and nursing. They all come together and they have to make decision, they have to ensure the proper care and management of the patient. Many of these interactions are not based on authorities. Many of these interventions are not governed by the supervisor subordinate relationship. In fact, these are not reporting relationship most of the time, they are peer professionals based relationships. So, learning from others and analyzing and developing the best case strategy for a patient are very important aspects of quality medical practices in these situations. In this situation, the most important OD interventions can be, now we are towards the end of this course, you can also think about what might be the unique OD interventions. Obviously, based on this description of the organization design systems and processes of the hospitals and their management challenges, we can see that cross functional team building, intergroup interventions, group clarification, role clarification based intervention can be very useful in the hospitals. There is another very important aspect of the profession of medical care. You must have observed that junior doctors learn skills and sharpen their knowledge by working with senior doctors from different fields and these two are not reporting relationships. They operate in the context of traditional organization structure that is cylindrical in nature, but these are mostly the relationship of teacher and taught. Secondly, learning in patient care delivery involves very high tacit component of knowledge which takes place in an apprenticeship mode with observation, sharing, mentoring across members of the teams rather than reflecting the classical hierarchical control paradigm. So, we see that learning and development in the health care sector, in the field of health care, do not follow a supervisor subordinate relationship predominantly. It is mostly a coach and coachy kind of relationship, mostly mentoring and mentor and mentee kind of relationship. So, in light of this fact, mentoring seems to be very important and useful intervention wherein we can give inputs about the best mentoring practices to the senior professionals and we can also give key inputs how to be a good mentee and how to draw maximum benefit from the knowledge and perspective of mentor that input can be given to the young professionals. Learning is useful, it is rather required in most of the career stages of experts or doctors in the who are the key actors in the health care system. Dr. Atul Gawande from USA has written extensively about it. We also see that as the new technology keep coming, new molecules are discovered, new methods and new processes of the disease management keep coming up in the field of medical sector. There is also a possibility of reverse mentoring wherein relatively younger employee or relatively younger doctor or younger professional teaching or mentoring to the senior professional. We can also see some of the human resource management process based OD interventions. You might recall our session on HRM based OD intervention and many of the concepts can be specifically relevant in the hospital sector or in the health care sector. HRM function in hospitals has to add value by building effective patient care delivery teams that can create high contribution through collaboration, patient satisfaction and quality care. Many traditional HR practices must be redesigned to meet the short term operational pressures while catering to long term strategic goals of the hospitals and these practices can be related to staffing and also very much related to the culture building in hospitals. Using the performance of doctors and linking them to rewards can also be one of the key HRM based intervention in the hospitals. We can look at performance management system, multilevel incentive systems, financial rewards aligned to the strategy and approach to the work, system design or system redesign. These are the HRM related OD interventions which can be very relevant for the hospitals. One hospital might be aiming to serve large number of the patients coming from the lower socioeconomic strata. Another hospital might be focusing on the medical tourism or aiming to cater the premium segments people having the high capacity for the payment and these two organizations will have different focus of their patients, different focus of their strategy. So, accordingly they need to design the incentive plans, accordingly they need they have to design the financial reward system for the doctors and the other professionals working in the hospital and that those strategic perspective and operational perspective need to be looked at by the HR function and based on that they can redraw the incentive systems or performance evaluation system for the professionals working in the hospital or in other health care system. As a doctor's professional competency involves both interpersonal and technical skills, evaluation metrics also must be comprehensive and they should cover both aspects adequately. Though if we look at the reward system implemented in most of the healthcare delivery systems it is not yet seem to recognize the significance of the managerial element among the professionals and thus do not reflect the changing priorities of the organizations. There are several studies which are highlighting the slow diffusion of the modern management practices and technology innovations in health care. One example is the implementation of the EMR in a large percentage of the health care delivery system is suboptimal and can be said not to be successful. So, in light of these facts we also need to have leadership development as a orient intervention for the key senior decision making level levels in the health care system and health care delivery system. Technology and process implementation are becoming more and more important, but we already have discussed that technology and process implementation in hospital in no way going to reduce the importance of the human to human interaction and import and care and ethical aspects of service delivery. One example is telemedicine we are recording this session at the time of COVID-19 pandemic. We all know that because of this pandemic patients with the different diseases different health related problems also are suffering because they are not advised or they are not they are afraid of visiting to the hospitals. So, in this kind of environment telemedicine naturally becomes a preferred way of consultation for the patients who need advice for their general regular health ailments, but the telemedicine to be successful not only requires technology, but it requires proper record keeping, proper rapid building and the comfort of the service providers to that internet based environment. We also need to recognize the need for OD in the allied fields in the health care sector. Allied fields meaning people and professionals other than the doctors who are the integral part of the health care system or health care delivery system. Growth of the health care sector in India has been the entry of health insurance third party administrators who have created several new positions. In particular segments like clinical trials, actuarial services in the health insurance these are two areas in which large number of professionals are required and will be required. To overcome the acute shortage of skilled employees in these emerging fields we found that organizations are introducing job rotation among their existing employees in an effort to move them into new roles. This trend is going to continue or may increase in the near future. Another common practice is to hire people from other related fields. So, as a result organizations are investing heavily in training and development of these employees and thus raising their human development cost. These are some of the challenges for OD pertaining to the management of the human resources working in the allied field in the health care sector. Another problem is that these training programs may help develop talent for the short run, but they cannot replace the formal and standardized curriculum a standardized curriculum of a university. Organizations have therefore started to form partnership with the universities to design courses and build curriculum for these emerging fields at the national level. But what I am talking about are very few hospitals which have been proactive in forging this kind of collaboration. What is needed is the collaboration at the industry level, collaboration at the sectoral level wherein the representative of the health care sector or the allied fields of the health care sector have a common understanding with the universities and other education providers to develop the curriculum which will help to prepare the professionals for the allied fields in the health care system. Most of the large hospitals chains now are having their own nursing schools. Finding good training good nurses and ensuring they remain with the hospital is one of the major HR related challenges in the hospital systems. So, hospitals have also started to take the fresh graduates from the nursing colleges, they provide them further training in order to socialize them to the organizational values and culture and also to understand the nuances of the health care in the practical field in the apprenticeship form and that is a commonly used intervention to ensure the sustainable talent supply for the nurses for the role of nurses. There are few noteworthy examples, one of the large hospital designed and implemented a workforce differentiation strategy. What does that mean? It means they discriminated between care and cure employees and that discrimination enabled them to adopt different HR practices for two sets of employees. In another hospital the selection process for nursing staff was changed to recruit graduates from college without experience. On other hand specialists were recruited based on on the referrals from existing employees. So, use of these kind of differentiated policies for different sets of employees have provided greater flexibility to help these organizations hospitals which have taken these initiatives to deal with the unique challenges which we talked about just now. When we are talking about health care system or health care delivery system in India, we must discuss about some of the great innovations which have happened in the field of health care in India. There are so many, we will look at only five examples in this session. First example is Arvindayakir. So many case studies are written on the Arvindayakir. The major reference is taken for this session is from the paper of Professor Vasanthi Srinivas and Dr. Chanwani. They have also written some very interesting case study on the Arvindayakir, participants can have a look at that. Arvindayakir has grown into a network of eye hospitals and has had a major impact in eradicating cataract related blindness in India. Performing surgeries on large scale is its unique feature. They do it with the treatment which is almost free or heavily subsidized for the poor across subsidized by the paying patients that is done through extensive outreach programs. So, they have collaboration with the different social clubs in organizations where clubs arrange for the site and the physical facilities for the operation and the Arvindayakir provides a free services by the doctors and the nursing staff to carry out these operations. Arvind focused on rotating doctors between free and paid ward. This was a very important and a key intervention in the by the Arvindayakir that they that they have not created separate carder or separate group of doctors and service provider for the patients who are who are paying and for the patients for whom the cure and the disease management is almost free of cost. To ensure that there is no service difference provided to the two categories of the patients they have found this OD intervention of the job rotation of the doctors very interesting and very useful. In this way they are concentrating on the efficiency and hygiene and also eliminating the difference between surgeries done for the two categories of the patients. Another example comes from the Shankar Nithrali. According to Nani Palikivala the great law luminary and the former Indian ambassador to USA they just he describes Shankar Nithrali as the best management charitable organizations in India. Shankar Nithrali has over 1000 employees and serves around 1500 patients per day. They are performing over 100 surgeries per day they are running 5 locations they are running hospitals and facilities in 5 locations in Chennai and have also services at the various locations. Unique intervention or the unique feature of Shankar Nithrali is also starting their own college. In those colleges they have introduced some certificate courses very relevant for the field of healthcare particularly in the field of ophthalmology. These certificate courses are ophthalmometry, bachelor of optometry or courses of BSc and MSc in the medical laboratory technology, masters of optometry. So, these are the unique courses designed according to the need of that sector and that is the unique intervention of Shankar Nithrali along with providing the very high quality services at the very reasonable cost to the people who need it. Narayan Hirthalai is again a great example it is a Bangalore based affordable healthcare founded by Dr. Dini Shetty and this chain has not 21 medical centers across India and they are also known for its low cost and high quality services. Another example is life spring hospital that is relatively new that is relatively new organization they provide low cost maternity care hospital they provide low cost maternity care. At the moment they have 10 branches and 8 extension centers mostly in Hyderabad and also in Vishakhapatnam. So, in last 3 years life spring hospital has delivered around 20,000 healthy babies. We also have an example like LV Prasad Eye Institute and that was named after great film personality LV Prasad Dada Sahab Falke awardee as well. They provide affordable eye care to poors and approximately 50 percent of their services are rendered free of cost to the economically underprivileged patients. That is also a charitable form and they also focus on the high level of efficiency and the very smart financial management to keep the to retain the talent and also to provide the very high quality service to the patients of the different sectors and different status of the economic prosperity. So, some of the key notions about OD intervention in the health care sectors are that there are some contextual factors like privatization, emergence of the allied fields. They are causing the talent shortage in the field of health care sector. Development of the new business model is a unique aspect unique feature of health care sector in India and there can be large number of OD interventions which we discussed which we studied in the earlier sessions of this course are very much required and can be implemented in the health care sector or health care delivery system like hospitals. These interventions are team building, coaching, mentoring, redesigning the PMS, infusion of the management tools, methods. In fact, there are also some operational management related models like Six Sigma, Lean. These things the principles of Lean and Six Sigma can also be implemented in the health care sector.