Dr Bhagwan Koirala and the change program at Shahid Gangalal National Heart Centre (SGNHC)

We try to analyze the change program at SGNHC under the leadership of Dr Bhagwan Koirala. We compare the process with the 8-step Change Management Model proposed by John P. Kotter. 

The 8-step Change Management Model and Change at SGNHC

Figure: 8-step Change Management Model and Transformation at SGNHC

The transformation at SGNHC from a small hospital catering only OPD services to an international standard heart care center was possible due to the team-spirit, capability and dedication of the employees under shrewd leadership of Dr. Koirala. Personal financial interests and nepotism were discouraged, while punctuality in service was developed.

Dr. Koirala followed majority of the 8-step change management model to bring about the transformation at SGNHC. He met with the employees and brought about the sense of urgency from Day-1. He portrayed dire situation of the hospital and generated employees drive towards change. Senior doctors were consulted to create a common agenda for the hospital. The vision was a set, which was mutually acceptable to the existing employees. The vision was communicated to the employees repeatedly through meetings.

The best way to communicate expectations is by demonstrating them. Leading by example was the motto of Dr. Koirala at SGNHC. He listened to every grievance from the employees and tried to instill service mentality among the employees. 

Doctors at SGNHC were encouraged to go for international exposure and learn best practices in the field from respected international institutes. Innovative ideas to improve the quality of operation and thus the service rendered to patients were supported. 

Change was implemented in an incremental process. Day-to-day improvement was emphasized. New improvements were initiated once the older ones were institutionalized. Systems and procedures were made more powerful than the people. Starting from selecting patients for free-care and free-services to appointing of staff to provision of resources, everything was made procedural. Accountability of actions was instigated.

The change process did have some areas of improvement too. Although the doctors were encouraged for exposure, administration team was not groomed to develop better managerial expertise. Formal trainings and development programs were not carried out to develop service mentality among employees. Similarly, succession planning at SGNHC was not developed. This led to some friction (although temporary) while building on the change process, once Dr. Koirala stepped down from the executive director post.

Overall, it seems Dr. Koirala had succeeded in his vision of developing SGNHC into an international standard facility. From just an OPD ward to a 150 bed heart care centre, the institution has served a huge population of Nepalese heart patients. Costs of heart surgeries are very minimal (basic closed heart by-pass surgery costs about 80,000 to 90,000 Rupees). Mortality rate of the operations are at par with American public hospitals. Over 1200 heart surgeries are done per year. With innovative financial operations like cross-pricing (cabin beds are priced higher so that some beds can be allocated for needy and poor for free), the institution has made heart care accessible and affordable to many. Above all, it has generated hope among Nepalese, that good things are possible in Nepal. Behind this hope is the leader – Dr. Bhagwan Koirala.