The Impact Doctor: A Day in the Life of Devi Shetty

Devi Shetty is chairman and founder of Narayana Health, a low-cost hospital network in India that brings high-quality, affordable healthcare to the masses. Founded in 2000, it now has 49 hospitals and care facilities across India, plus a hospital in the Cayman Islands, and about 17,000 direct employees. The company listed on the stock exchange in 2016 and reported revenues of US$ 325 million in 2018. In October last year, Shetty was named as Impact Entrepreneur of the Year in the prestigious GSG Honors. Shetty’s typical day involves software, surgeries and seeing dozens of patients – and he wouldn’t change it for the world

As soon as I wake up, I do the rounds in the ICU from my bedroom. An app allows me to see all my patients’ cardiac monitor, blood test reports, and so on. It’s as good as being there.

I’m fanatical about fitness, and exercise every morning. I used to do martial arts, but now I only do yoga and weight training. It’s too early to have breakfast with my family – I get up at around 4.30am – so I eat at the hospital later, usually dhosa or idli.

The first patient is taken to the operating room by about 6.30am. I’ve forgotten how many heart operations I’ve done: maybe 30,000? I don’t get involved in daily business meetings. I have a fantastic team of people who take care of that. So the rest of the time, I’m seeing patients – about 60-100 every day. It’s energising. Where else do you get to interact with that many people?

More than 70% of my patients are working class and poor; they come to us under various government schemes. The majority of entrepreneurs in India have a social angle: in the midst of poverty you can’t turn your face away. And people are beginning to realise it may be a good business strategy. If you’re only concentrating on people who can afford your services, there is always a limited market. The moment you reduce the costs, the market is virtually infinite.

 

Targeting the poor

Rather than targeting patients at the premium end of the market, Narayana Health specifically aims to reach the working class and poor. It serves some 2.6 million patients each year, two-fifths of whom need financial support to pay for treatment. This is provided by the company itself through its own foundation, corporate sponsors or crowdfunding platforms. It also subsidises their costs through fees paid by premium patients.

 

In India if you don’t think big, you won’t make any difference. India requires 2 million heart surgeries a year; we have a high incidence of heart disease and diabetes. That’s a huge unmet need. Last year we did 17,000 – the UK’s NHS does about 30,000.

Thirty years ago I did my first heart surgery in Calcutta. The patient paid US$2,000; today we do the same for US$1,200. We reduced costs through economies of scale. We spent millions of dollars on software, but because of the number of patients we have we can afford it. If you have a 200-bed hospital you can never afford that kind of thing. If you buy a CT scan, most hospitals would use it for about eight hours a day, five days a week. We use it for at least 16 hours a day.

If you’re only concentrating on people who can afford your services, there is always a limited market

The challenge of operating at scale is in the number of patients coming to your facility. There’s a huge cost to maintaining facilities: doors start coming off the latches!

I bring my lunch from home, and colleagues join me to discuss patients or maybe the software we’re developing. We’re non-vegetarian so we have fish or chicken with rice, and I eat a lot of salad, grown on our farm.

Around the world, 90% of people have no access to electronic medical records. We have a very ambitious plan of building a modern hospital management system. We want to take away pen and paper – the culprit when it comes to safety. When something goes wrong you should be able to track it. With pen and paper there’s no timestamp.

Today our entire patient management happens on this platform we’re building. Right now we’re in the iteration phase but at some point we want to offer it to other hospitals. It’s like what Amazon did – they had a Cloud for their own needs, but their requirements were so big and they had so much space, they started renting it to others. For us it will be a way of generating some income, but hospitals will just pay per usage: 5 rupees per day per patient – the cost of one disposable plastic syringe.

I do get out of the hospital sometimes – travelling to Delhi to talk to government about universal health care. I believe India will become the first country in the world to successfully dissociate healthcare from affluence. How close are we to that point? Maybe five or 10 years away. It can only happen by working with the government. We need to reform medical and nursing education and train a lot more medical specialists. And there should be regulatory changes in building and managing hospitals, and more encouragement from government to invest.

Every business should, every five years, introspect and re-look at its business model 

Poor people in isolation are very weak. But together they are very strong. A while ago we convinced Karnataka state government to launch health insurance aimed at poor farmers. The state government will contribute an amount equal to the premium collected from farmers and will also cover for any excess claim beyond the premium collected. In about 13 years, over 1.5 million farmers had various surgeries – all of them done by paying 11 cents per month.

I’m generally home by about 9.30pm. I’ve been practising for over 40 years, but I'm not thinking of retiring – no way. I don’t have a dream for my company, but I want to see that everyone on the planet has access to high-tech healthcare with dignity, without having to beg or borrow – like what the NHS does.

I’m a great fan of the NHS. I think it’s the model which every part of the world should emulate. But every business should, every five years, introspect and re-look at its business model. You can’t keep doing what you did 20 years ago.

Dr Shetty was named Impact Entrepreneur of the Year in the 2018 GSG Honors.