Manipal Health Enterprises, today is a leading multi-specialty healthcare organization, with 15 hospitals and clinics located across the continent. With a workforce of over 5300 employees, it aims to provide affordable tertiary care that follows a multispecialty healthcare framework. The foundation of this conglomerate has been built on its values of clinical excellence, patient centricity and ethical practices. Was this their story 27 years ago? Let’s find out!

1. MANIPAL -
THE TRANSFORMATION STORY
1
www.greatplacetowork.in
by
Rashmi Mutt & Sandhya Ramesh

2. The challenge extended to business a
and profitability, keeping the service-
of its strategy re-engineering across t
That time, they were faced with busin
Business Challenge What
Scale up revenue They
Improve customer
experience
The n
with l
Control uncertainty in daily
operations.
Daily
nurse
of tale
By now, Manipal had realized that
customers also need to be aligned to
related challenges cited by leaders we
High attrition in th
abroad and the emergenc
Lack of collaboration
Challenging to attra
preferred employer for gr
P a g e 2 | 6
The challenge extended to business as well as people. It was centred around how to focus on growth
and profitability, keeping the service-orientation alive. Come 2012, Manipal found itself at the peak
of its strategy re-engineering across the 10 hospitals.
That time, they were faced with business challenges like:
Business Challenge What did this mean?
Scale up revenue They were at 853.86 crores.
Improve customer
experience
The net promoter’s score, a key organizational health index was at 68–
with lowest scores on F&B and the Discharge process.
Control uncertainty in daily
operations.
Daily operations were being affected by incidents caused due to
nurses’ agitation, loss of talent, and inability to attract the right type
of talent.
By now, Manipal had realized that to become a differentiated healthcare provider, the internal
customers also need to be aligned towards its vision of Partnership model. A few common people
related challenges cited by leaders were:
High attrition in the nursing department owing to better opportunities available
abroad and the emergence of new healthcare operators in India.
Lack of collaboration between the clinical and non-clinical workforce.
Challenging to attract good talent for key roles, as hospitals were not perceived as a
preferred employer for growth opportunities.
2
Manipal Health Enterprises, today is a leading multi-specialty healthcare organization, with 15
hospitals and clinics located across the continent. With a workforce of over 5300 employees, it aims
to provide affordable tertiary care that follows a multispecialty healthcare framework. The foundation
of this conglomerate has been built on its values of clinical excellence, patient centricity and ethical
practices. Was this their story 27 years ago? Let’s find out!
The Early Days
Manipal Hospital was founded in 1991, as a trustee-owned healthcare provider. As the years
progressed, Manipal realised that to cater to the widespread need for world-class healthcare in the
country, it would be important to spread its wings over multiple regions. By 2005, the hospital had
organically grown its network of hospitals and extension centres, but was still concentrated in and
around parts of South India.
A Sudden Shift
In 2005, to spur growth, key leaders at MHEPL strategized that to expand their network, they would
follow an “acquire and integrate” model.
However, this required a mammoth change; one that could not take place overnight. One that
involved a transition - from a Paternalistic model to a Partnership framework.
In a Paternalistic model, the hospital continues to operate in the form of a Trust, providing affordable
healthcare with reasonably upgraded infrastructure and technology. However, in a partnershipmodel,
it is critical for every partner hospital to conduct daily operations keeping in mind, investment in
Clinical Excellence as well as Technology, so they can provide world-class care to a larger pool of
patients. MHEPL was thus faced with a new challenge – how to keep the element of trust between
its partner hospitals and people, while moving up the value curve?
The Industry Struggle:
To provide world-class treatment and care, hospitals need to make continuous investment in areas of
R&D and upgradation of technology /infrastructure. The healthcare scenario in India appeared gloomy
back then (continues still). There was only 1 hospital bed available for every 1000 citizens, whilst the
World Health Organization recommends an average of 2.9 beds.
In 2014, as per India Today reports, the healthcare sector had very poor Doctor: Patient ratio, which
was at a dismal 1:2000, and the Indian Government’s spending on healthcare, was only around 0.5%
of its GDP. According to an article published by Economic Times, this sector presented very few
growth opportunities and hence there was a deficit of required as well as trained skills, specifically
physicians, laboratory professionals, nurses and paramedics. In addition, the younger generation
was not drawn to this sector, thereby leading to a further shortage of talent and manpower.
QUICK FACTS:
15 hospitals across Asia
6,000 beds
Consolidated Turnover of INR. 1600 Cr.
Diversified Services in Home Care, Information
Centre, Ambulance Rescue Service, Robotic
Surgery, IBM Watson

3. The challenge extended to business a
and profitability, keeping the service-
of its strategy re-engineering across t
That time, they were faced with busin
Business Challenge What
Scale up revenue They
Improve customer
experience
The n
with l
Control uncertainty in daily
operations.
Daily
nurse
of tale
By now, Manipal had realized that
customers also need to be aligned to
related challenges cited by leaders we
High attrition in th
abroad and the emergenc
Lack of collaboration
Challenging to attra
preferred employer for gr
P a g e 2 | 6
The challenge extended to business as well as people. It was centred around how to focus on growth
and profitability, keeping the service-orientation alive. Come 2012, Manipal found itself at the peak
of its strategy re-engineering across the 10 hospitals.
That time, they were faced with business challenges like:
Business Challenge What did this mean?
Scale up revenue They were at 853.86 crores.
Improve customer
experience
The net promoter’s score, a key organizational health index was at 68–
with lowest scores on F&B and the Discharge process.
Control uncertainty in daily
operations.
Daily operations were being affected by incidents caused due to
nurses’ agitation, loss of talent, and inability to attract the right type
of talent.
By now, Manipal had realized that to become a differentiated healthcare provider, the internal
customers also need to be aligned towards its vision of Partnership model. A few common people
related challenges cited by leaders were:
High attrition in the nursing department owing to better opportunities available
abroad and the emergence of new healthcare operators in India.
Lack of collaboration between the clinical and non-clinical workforce.
Challenging to attract good talent for key roles, as hospitals were not perceived as a
preferred employer for growth opportunities.
3
With 50+ years of presence as an entity, Manipal wanted to seize this opportunity to grow and serve
the community at large. By 2012, it had expanded its network of hospitals to 10, and was embarking
on acquiring hospitals in the rest of the continent.
The Journey Towards One-Manipal
However, come 2014, Manipal found itself amidst critical challenges:
Business Challenge What did this mean?
Increase revenue growth They were at INR. 853.86 crores.
Improve customer
experience
The net promoter’s score, a key organizational health index was at 68
– with lowest scores on F&B and the Discharge process.
Control uncertainty in daily
operations.
Daily operations were being affected by incidents caused due to
nurses’ agitation, loss of talent, and inability to attract the right type
of talent.
The challenge did not lie just in integrating and standardising the quality of service across the
numerous acquisitions they had performed over the years. The challenge extended to both; the
business as well as people. Every hospital they acquired came with its own, unique culture. One that
could be very different from what was already existing at Manipal. Some of their People challenges
were:
People Challenge What did this mean?
Attrition in Nursing Trained nurses were leaving for better opportunities abroad/ in new
healthcare operators.
Diverse interests Lack of collaboration between clinical and non-clinical workforce.
Industry & Employer Brand Inability to attract good talent for key roles, as hospitals were not
perceived as a preferred employer for challenging careers.

4. The challenge extended to business a
and profitability, keeping the service-
of its strategy re-engineering across t
That time, they were faced with busin
Business Challenge What
Scale up revenue They
Improve customer
experience
The n
with l
Control uncertainty in daily
operations.
Daily
nurse
of tale
By now, Manipal had realized that
customers also need to be aligned to
related challenges cited by leaders we
High attrition in th
abroad and the emergenc
Lack of collaboration
Challenging to attra
preferred employer for gr
P a g e 2 | 6
The challenge extended to business as well as people. It was centred around how to focus on growth
and profitability, keeping the service-orientation alive. Come 2012, Manipal found itself at the peak
of its strategy re-engineering across the 10 hospitals.
That time, they were faced with business challenges like:
Business Challenge What did this mean?
Scale up revenue They were at 853.86 crores.
Improve customer
experience
The net promoter’s score, a key organizational health index was at 68–
with lowest scores on F&B and the Discharge process.
Control uncertainty in daily
operations.
Daily operations were being affected by incidents caused due to
nurses’ agitation, loss of talent, and inability to attract the right type
of talent.
By now, Manipal had realized that to become a differentiated healthcare provider, the internal
customers also need to be aligned towards its vision of Partnership model. A few common people
related challenges cited by leaders were:
High attrition in the nursing department owing to better opportunities available
abroad and the emergence of new healthcare operators in India.
Lack of collaboration between the clinical and non-clinical workforce.
Challenging to attract good talent for key roles, as hospitals were not perceived as a
preferred employer for growth opportunities.
4
Therefore, seven years later, although they had grown by 10 hospitals, MHEPL had to now start
focusing on integrating the acquired hospitals into their vision of One Manipal!
To understand employee sentiments better, as well as to focus their effort in the right areas, Manipal
undertook the Great Place to Work® survey in 2014. The key highlights from the survey were:
Keeping in mind the business need, as well as the current industry challenges; the HR Department at
Manipal designed new strategies in the areas of Hiring, Training & Career Development, Rewards &
Recognition; to attract key talent, develop top performers as well as retain seasoned employees.
Ekta – Innovating Through Collaboration
One such initiative was Ekta. As part of Ekta, task-force teams come together, to pick up key business
issues. During the survey conducted in 2014, one of the employees shared; “There are many people
who can deliver at much higher levels of potential; empower them, trust them, side-lining them is not
the solution.”
With the objective of empowering its people to take decisions and continuously improve processes,
groups of employees designed, presented and implemented solutions through a structured and
guided process. There were numerous Lean-out workshops conducted under this umbrella. For
example, just by applying Lean Six Sigma to the nursing handover process, the team reduced handover
time in the Nursing department.
Hospitals Existing Handover
Time
New Handover
Time
Efficiency
Goa 98 minutes 35 minutes 64.29%
Jaipur 60 minutes 30 minutes 50%
Bangalore 66.53 minutes 43.4 minutes 34.77%
S
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S

5. The challenge extended to business a
and profitability, keeping the service-
of its strategy re-engineering across t
That time, they were faced with busin
Business Challenge What
Scale up revenue They
Improve customer
experience
The n
with l
Control uncertainty in daily
operations.
Daily
nurse
of tale
By now, Manipal had realized that
customers also need to be aligned to
related challenges cited by leaders we
High attrition in th
abroad and the emergenc
Lack of collaboration
Challenging to attra
preferred employer for gr
P a g e 2 | 6
The challenge extended to business as well as people. It was centred around how to focus on growth
and profitability, keeping the service-orientation alive. Come 2012, Manipal found itself at the peak
of its strategy re-engineering across the 10 hospitals.
That time, they were faced with business challenges like:
Business Challenge What did this mean?
Scale up revenue They were at 853.86 crores.
Improve customer
experience
The net promoter’s score, a key organizational health index was at 68–
with lowest scores on F&B and the Discharge process.
Control uncertainty in daily
operations.
Daily operations were being affected by incidents caused due to
nurses’ agitation, loss of talent, and inability to attract the right type
of talent.
By now, Manipal had realized that to become a differentiated healthcare provider, the internal
customers also need to be aligned towards its vision of Partnership model. A few common people
related challenges cited by leaders were:
High attrition in the nursing department owing to better opportunities available
abroad and the emergence of new healthcare operators in India.
Lack of collaboration between the clinical and non-clinical workforce.
Challenging to attract good talent for key roles, as hospitals were not perceived as a
preferred employer for growth opportunities.
5
Not only did this improve the efficiency, but it also impacted the overall customer satisfaction scores
positively.
Mr. Pramod Alagharu, CEO, Manipal Health Enterprises Dwarka Pvt. Ltd., spoke gravely about having
a discharge process so cumbersome; not only was is it leading to high dissatisfaction of customers, it
was also leading to loss of revenue. He went on and then described the efforts of an Ekta team, that
devised solutions which reduced the discharge time by half, for all transactions.
Customer Satisfaction Scores 2014 2017 Impact
Discharge Queries 77.23 89.96 12.73
Discharge Process 72.93 87.13 14.2
Discharge Time 75.01 88.97 13.96
MANIP & Drona – Engaging Key Talent!
Prior to 2014, daily operations were plagued by agitations; mostly from the Nursing department. For
the young nurses, Manipal was perceived as a quick training ground before they could chase more
lucrative opportunities. The tenured nurses were found to have become redundant in their roles. Mrs.
Saroja, Chief Nursing Supervisor, recollects “Skills were there, but we were not tapping it. There was
a stagnation in our senior nurses.”
In the year 2014, Manipal introduced a structured induction program called MANIP. To follow it up
with a holistic development opportunity, they also:
- Introduced the Balanced Score Cards, defined KRAs, and included a parameter of customer
feedback for nursing care.
- Increased communication by creating Customer Experience Champions across locations.
- Trained nurses on Process Compliance parameters.
- Launched Drona, a platform which gave senior nurses, paramedics and operations staff a
chance to hone their leadership skills as well as mentor fresh entrants in the nursing division.
This program not only gave tenured nurses an opportunity to showcase leadership skills but
also created subject matter experts. Soon, Dronas started springing up across hospitals, in
Administration, Paramedical and Support Functions too.
Training & Development metrics 2014 2017
Number of Dronas in the system 13 17
Number of programs conducted 26 190
Training man-hours 2300 14600
While man-hours grew by over 6 times, training effectiveness also increased!!
MANYATA - Rewarding not only performance, but also demonstration of values
To drive a high-performance culture, it is important to inspire employees to perform well and
recognize top performers. While faced with challenge of saving lives, every single day, one could very
easily forget to appreciate and recognize smaller efforts that go in!
The trustee-owned Manipal had minimal focus on rewarding employees. While employees felt their
efforts were tied in to a higher sense of purpose, they felt a lack of appreciation from the top
leadership.

6. The challenge extended to business a
and profitability, keeping the service-
of its strategy re-engineering across t
That time, they were faced with busin
Business Challenge What
Scale up revenue They
Improve customer
experience
The n
with l
Control uncertainty in daily
operations.
Daily
nurse
of tale
By now, Manipal had realized that
customers also need to be aligned to
related challenges cited by leaders we
High attrition in th
abroad and the emergenc
Lack of collaboration
Challenging to attra
preferred employer for gr
P a g e 2 | 6
The challenge extended to business as well as people. It was centred around how to focus on growth
and profitability, keeping the service-orientation alive. Come 2012, Manipal found itself at the peak
of its strategy re-engineering across the 10 hospitals.
That time, they were faced with business challenges like:
Business Challenge What did this mean?
Scale up revenue They were at 853.86 crores.
Improve customer
experience
The net promoter’s score, a key organizational health index was at 68–
with lowest scores on F&B and the Discharge process.
Control uncertainty in daily
operations.
Daily operations were being affected by incidents caused due to
nurses’ agitation, loss of talent, and inability to attract the right type
of talent.
By now, Manipal had realized that to become a differentiated healthcare provider, the internal
customers also need to be aligned towards its vision of Partnership model. A few common people
related challenges cited by leaders were:
High attrition in the nursing department owing to better opportunities available
abroad and the emergence of new healthcare operators in India.
Lack of collaboration between the clinical and non-clinical workforce.
Challenging to attract good talent for key roles, as hospitals were not perceived as a
preferred employer for growth opportunities.
6
This gave rise to a holistic rewards and recognition platform; Manyata! However, during the initial
years, it did not get the positive perception it set out to meet. In the Great Place To Work, survey, held
in 2014, one of the employee’s shared, “Manyata program has been started in our organization but it
is not given for hard-working or honest people. It is given only for the people who favour managers
and work as they like.”
Another employee added, “Managers are partial; gradings for the employee are not based on the
experience or qualifications. It’s just based on whom the manager likes. Manyata awards are not given
to the people who deserve it.”
However, Manyata evolved further and is now the most looked forward to award among all
employees at Manipal. Popular among all departments; including Housekeeping,Security,and support
functions; this program inspires employees to perform well, and rewards those who demonstrate core
values of Manipal. From simple appreciation cards, to annual awards, Manyata became a celebration
that employees eagerly look forward to. In the most recent survey held in 2017, one employee wrote,
“Appreciation is given to the right person. They identify the right person’s effort and award them
accordingly. Manyata has made a difference in the organization.”
Did the needle move?
Yes, it did!!
When Great Place to Work® came back to survey employees at Manipal in 2017, 83% of the employees
believed it is overall a great workplace; marking a 22% positive increase from their feedback in 2014.
To ensure Candid Communication, leaders started communicating more frequently through
Townhalls. To ensure higher involvement of employees in decision making, various initiatives like Ekta,
People Manager Initiative, LamHE, AGELs and other committees provided a platform to voice
suggestions that helped improve business performance as well. To build a positive perception on fair
performance management, goal setting and KRA’s became well-defined and alternate paths for career
growth were chalked out for the tenured employees.
This is how the other improvement areas that were identified moved over the years 2014 to 2017:
29%
23%
26%
27%

7. The challenge extended to business a
and profitability, keeping the service-
of its strategy re-engineering across t
That time, they were faced with busin
Business Challenge What
Scale up revenue They
Improve customer
experience
The n
with l
Control uncertainty in daily
operations.
Daily
nurse
of tale
By now, Manipal had realized that
customers also need to be aligned to
related challenges cited by leaders we
High attrition in th
abroad and the emergenc
Lack of collaboration
Challenging to attra
preferred employer for gr
P a g e 2 | 6
The challenge extended to business as well as people. It was centred around how to focus on growth
and profitability, keeping the service-orientation alive. Come 2012, Manipal found itself at the peak
of its strategy re-engineering across the 10 hospitals.
That time, they were faced with business challenges like:
Business Challenge What did this mean?
Scale up revenue They were at 853.86 crores.
Improve customer
experience
The net promoter’s score, a key organizational health index was at 68–
with lowest scores on F&B and the Discharge process.
Control uncertainty in daily
operations.
Daily operations were being affected by incidents caused due to
nurses’ agitation, loss of talent, and inability to attract the right type
of talent.
By now, Manipal had realized that to become a differentiated healthcare provider, the internal
customers also need to be aligned towards its vision of Partnership model. A few common people
related challenges cited by leaders were:
High attrition in the nursing department owing to better opportunities available
abroad and the emergence of new healthcare operators in India.
Lack of collaboration between the clinical and non-clinical workforce.
Challenging to attract good talent for key roles, as hospitals were not perceived as a
preferred employer for growth opportunities.
7
Did this have any impact on their business?
While they saw a steady growth in revenues; the customer experience improved significantly.
Business Challenge 2014 2017
Current Revenue (in Cr.) 853.86 1406
Customer Experience 68 84.8
What did employees have to say about the Transformation?
According to focused group discussions, covering over 50 employees across departments; held by
Great Place to Work in October 2017, we find:
a) Employees perceive an improvement in training and development programs offered to them.
This has led to capacity building for critical roles.
b) A new wave of recognition also came about, which made employees feel appreciated and
motivated them to perform better.
c) Increased transparency and open communication, gives them an opportunity to share
feedback regularly.
d) While scale of operations continues to grow, employees are being empowered to make
decisions and lead initiatives.
e) Along with this, has come better technology, infrastructure and facilities at the workplace.
What the future holds…
The integration of many cultures into one Manipal has given birth to many programs that got
institutionalized and are now synonymous with employees who have been part of them. With Values
at the core of everything they do; The Family Test – ‘do to your patient as you would to your family’
has helped thousands of employees through difficult decisions.
In the words of Mr. Ganesh Selvaraj, Senior General Manager & Head of Human Resources,
“Importance comes from identity – hence programs are conceptualized and rolled out for employees
to own and run”.
While Manipal continues to face business challenges like bridging the gap between increased costs
andincreased pricing, as well as continuous improvementin treatments offered; itwill needan equally
strong people strategy to attract the right type of talent and provide excellent career opportunities
that will excite and retain its key talent. Manipal continues to ride the waves of change, learning and
unlearning, but steadily forging its way towards building a high-trust high-performance culture.
References:
http://indiatoday.intoday.in/story/grim-picture-of-doctor-patient-ratio/1/654589.html
(https://health.economictimes.indiatimes.com/news/industry/skill-gap-a-wake-up-call-to-
healthcare-industry/46736989)