STRUCTURAL AUDIT

Organizational Structure

The organisation according to ‘classical science’ model and ‘Complexity Science’ Model can

be classified as Non-linear, and the assumptions apply to the organisation as the departments

of the organisations are non-reducible parts. The non-linear organisation structures are having

capability to self-organise each department and perform their functions efficiently. As the

organisation Arth Diagnostic is an entrepreneurship venture of Dr Arvider Singh and Dr

Rajendra Kachawa, the organisation tends to utilise its resources to the most optimum. The

organisation is always in the lookout for opportunities to capitalise, as Dr Arvinder told us

about the corporate venture that the organisation is looking as an opportunity to expand their

customer base. There is an absence of middle managers in the organisation as all the support

staff directly reports to the head of the department who is authorised to make the final

decision related to the majority of the functional processes in their respective departments.

Investment and strategic milestones for the organisation are taken by the CEO. Then

Marketing is the other function where the CEO has the direct responsibility to maintain

longterm relationships with doctors providing the patients to the diagnostics lab.

The authority related to long term decisions for the organisation is centralised and entirely

controlled by few individuals. There is a façade of involvement created by the senior

management for the support staff and paramedics to show that they are part of decision

making. But this feedback and suggestions are just for mostly all the long term, and strategic

decisions are made inline to the partners' motives. Uniform according to classical science

model as there is no other hierarchy under the departments and everyone is provided with

equal opportunity to show their worth in front of their department administrators. There is

also a uniform opportunity provided to everyone to learn and grow within the organisations.

There is a direct monetary benefit to the employees for getting multiple skills as their
compensation plan gets revised with every new ability they add. For learning this skill the

employees are supposed to be training after work hours under any department administrator,

who is generally a doctor so that their new skill is also acknowledged by the organisation.

The organisation is having minimum tendency of Controlling in the work the doctors do, but

for assuring high quality there are proper measures in place to monitor and improve the

service provided by the paramedics or technical support staff. The best example can be seen

in the case that there is a register maintained for all the instances where sampling required for

technician to prick the patient more than once, and this is considered a severe problem as the

patient will create a negative perception about the quality of service. This kind of strict

policies are controlling in nature, but they benefit the organisation in achieving its vision.

Flexible according to ‘Complexity Science Model’ this can be seen in the modern practices of

keeping the customer care as top priority to create maximum customer value. This practice

can be seen with the temporarily created reception on the first floor during the rush hours,

during this period all the employees present in the department of customer service and

reception desk come together so that the initial billing and form processing can be done in the

least time. There is also an IT-enabled customer interaction present in the organisation where

the queries and feedback from customer easily reach the top management. There is also high

integration as the CEO is present at the centre of the organisation; all the information flows

through him to various departments. The information flow from CEO to others is in the form

of Notices which is used formal communication and Sweets and messages for informal

dialogue.

Division of Labour
The organisation – Arth Diagnostics has a strong commitment towards providing highly

trained doctors and paramedics to provide the best possible service to the patients. For

achieving this objective, highly recognised doctors are hired, and they are given complete

autonomy over their work. There is a broad division in the organisation in terms of doctors

and other staff. Doctors are provided complete freedom of their choice of timings and amount

of work taken by them; this helps the organisation as the doctors who are part of the

organisation are highly motivated individuals and don’t need any monitoring. This strategy of

providing complete freedom in work to doctors has paid off as the organisation has achieved

recognition in quality of service by following NABH (National Accreditation Board for

Health Care) standards. The other staff is part of the Pathology Department, Radiology

Department or Customer Service/Reception. There is very minimal sharing of resources

between the departments. The lab technicians or paramedics are provided an opportunity to

gain more skills, and once they are multiskilled then they can be asked to help across the

divisions. But the upskilling of employees are entirely dependent on their self-motivation to

learn and grow.

Boundaries

Dr Arvinder Singh is the CEO and CMD of the organisation. He is a veteran as he has

several years of experience and exposure in the medical industry. Before joining ARTH

diagnostics as the CEO, he served in Dr Lal Path Labs, Delhi as the Vice-President. He also

served as the Rajasthan head of Piramal Diagnostics. Moreover, he was also the founder and

Director of Amolak X-Ray.

Dr Arvind diverse experience in the medical field and his skill set makes him most suitable

for the given role in the organisation. His responsibilities include developing high-quality
business strategies, making plans and taking definitive measures to ensure that they are

aligned with short-term and long-term objectives of the organisation He is the one who takes

all the decisions related to financing and advertising in the organisation. He takes care of the

recruitment of key people in the organisation like doctors and HODs of different departments

(Pathology and radiology). His responsibilities also include motivating and leading them to

bring out the best out of them, oversee all the operations and business activities to ensure the

desired results are produced and are in line with the overall strategy and mission of the

organisation.

Apart from the CEO, the other key people in the organisation include Dr Rajendra

Kacchawa, MBBS, MD, Director & Consultant Radiologist, Dr Syed Khursheed, Director

& Immunoassay Consultant, Dr Chandan Kumar Agrawal, MBBS, MD Consultant

Radiologist.

Dr Rajendra Kacchawa, a partner in the organization is the head of the radiology department

and takes several vital decisions along with Dr Arvind. There are 4 radiologists working

under his supervision. The decision-making authority for day to day matters rests with the

individuals as he cannot be a part of all the decisions that are being taken by the staff as it

does not require any expertise or specialised knowledge. However, Dr Rajendra is

responsible for the administration of the department as a whole, and all the radiologists report

to him. He is also responsible for evaluating the performance of radiologists and giving

appraisals based on the level of their performance. Radiologists are being helped by the

clerical staff who are mainly responsible for taking the patients inside and outside the treating

room.

The organisation also has 4 persons serving as computer operators, and there is one

receptionist who is common for both radiology and pathology departments.

There is a culture of mutual respect within the organisation. Everybody’s opinion is valued.

They are also sometimes being made part of the important decisions which are taken at the

highest level to give them a sense of belongingness in the organisation. The conducive

environment motivates them to work hard and put in their 100% efforts and take the

organisation towards its long goal of being the best in the southern part of Rajasthan.

However, there is no employee recognition program available in the organisation to reward

better-performing employee as it led to politics in the past. People started competing among

themselves to win the recognition of the top management and got involved in politics to bring

some harm to their potential competitor or threat so that they can remain ahead all the time.

This also led to reduced productivity of the workers. Because of unhealthy competition

among the employees, the CEO had to scrap the program. The firing of the employees is also

not being resorted to and only people exhibiting counterproductive work behaviour are dealt

with seriousness.

People facing difficulty in the organization are being handled directly by the respective heads

of the radiology of pathology department or by the CEO himself. Their problems are heard,

and concrete solutions are being provided by the concerned authority. This helps the

management to retain competent staff and bring down the recruitment cost as otherwise

vacancies are being posted on various employment sites such as Naukri.com and Shine.com

which brings up the overall cost of the organisation.

Information Flow
Arth Diagnostics is a small organization consisting of 80-85 employees. The Chief Executive

Officer (CEO), as well as the Chief Managing Director (CMD) of the organization is Dr

Arvinder Singh. He runs the organization along with his partner, Dr Rajendra Kachhawa. The

organization provides two kinds of services- Radiology and Pathology. Dr Kachhawa heads

the Radiology Department, and the CEO himself heads the Department of Pathology. The

heads of these departments are the heads of the organization only, so they are not answerable

to anyone.

Now we will talk about how information flows in these two different departments. First, we

will talk about the Pathology department. The Department of Pathology has two sections

under it- sample collection and the processing of those samples. The sample collection

section has no department head, but the lab administrator looks into the workings of this

section and reports back to the CEO as he is the head of the pathology department. The

department also has a lab manager who co-ordinates the functions of the department. The

Processing section of the department has three sub-sections- Biochemistry department in

which four people work, Immunoassay department in which two employees work, and

Microbiology department in which two people work and Dr Deepa Singh heads the section.

There is cross-functioning between the sections and sub-sections as the work is inter-linked,

so employees need to co-ordinate with each other a lot so that the information flows smoothly

between all the sections and sub-sections. There are three deputies as well in the pathology

department who directly report to the CEO.

Now, we will talk about the second department of the organisation, which is the Department

of Radiology. Four radiologists work in this department, and they report to Dr Kachhawa.

Radiologists make their individual decisions, and Head of Department is not involved in their
decision-making process. The Head of Department is engaged only in the decisions related to

the administration. The department also has a clerical staff which helps in bringing the

patients inside the lab and then outside the lab. The clerical staff reports to the Head of the

Department. In the Radiology Department, there is no cross-functional work, so the staff is

just busy in their work.

Other than these two departments, there is an independent reception and marketing

department that directly reports to the CEO. Also, there are four computer operators who take

over the work of the clerical staff of either of the departments in case of an absence, but

otherwise, they type the reports, and they are answerable to Head of Department of

whichever department they are working under. All the decisions related to finances like

salary structure, increments, etc. are taken by the CEO only.

Training

There is a pre-determined training period in the organisation. The time period differs from

one person to another; if a person is a quick learner and really enthusiastic then his/her

training period is short than the employees who do not grasp things quickly. The training

period can extend even for a period of six months. The training takes place after the working

hours gets over or one learns during their job only. During the training period, the trainees get

less salary and with experience and skill updation like taking samples as well as processing

them, their salaries increase.

Working Hours

The lab operates from morning 6 to evening 6, and the staff has a shift of 8-9 hours. The

attendance is marked on a biometric. They get a break of half an hour during their shift which
can be taken at any time. The doctor’s working hours is 6 hours, and some doctors even work

in two slots. The doctors are not limited to number of breaks, they can take a break at their

own leisure as according to CEO they are self-motivated so no interference in their break

time is required.

Appraisal

There is no process of internal appraisal in the organisation as according to CEO it leads to

internal politics in the organisation. So, they usually follow the organisational process to give

increments based on the profits made by the firm. But exceptions are there if someone does

some exceptional, he/she is rewarded accordingly. These outstanding performers are

recognised based on individual observation of the CEO or are recommended by the head of

department or the head of the sections or sub-sections.

Promotion

Since the organisational structure is flat, there is no possibility of advancement in the

organisation. With experience, the salary of the employees increases.

Employee Recognition

There is no scheme of employee recognition in the organisation as according to the CEO, it

leads to politics and if one is given recognition then others try to bring that person down.

Firing

Employees are not fired in the company except in the case of two situations which are

financial irregularities that is stealing and indiscipline.

Recruitment

Recruitment of key people like doctors and head of both the departments (Radiology and

Pathology) is done is through online apps like naukri.com and shine.com. However, there is

no formal procedure for the recruitment of supporting staff and other persons which do not

require specialised skills. Usually, people themselves approach the organisation for such

posts.

Retention of Employees

The employees are retained through various measures like giving timely appraisals and

bonuses for exhibiting exceptional performance. Everybody’s opinion is being valued in the

organisation and sometimes are also involved in certain vital decisions taken for the

betterment of the organisation. This gives the employees a sense of belongingness which

helps the top management to retain them.

CULTURAL AUDIT

Salary and employee’s satisfaction

Initially the employees at the lowest level who were basically the cleaning staff and the ones

who escorts patients for their tests were only given the basic salary of about 8k to 10k per

month. As the salaries were low, employees did not have job satisfaction and this was shown

in the high turnover ratio of the employees. Owing to the dissatisfaction of the employees
because of low salaries, management bought the change in the salary structure by providing

the incentives. The breakeven point for the organization is 4lacs per day, which mean any

amount above 4lacs fetches profits to the organization. The management decided to give 20%

of the basic salaries of those employees as incentives in order to motivate them and increase

the retention rate. Although the management tried to bring in the cultural change into the

salary structure, employees remained unsatisfied as they never considered the incentives or

variable pay which depends mainly on the day to day business as their basic salary. So,

management should take steps in such a way that the increment in the salaries should be

included in the basic pay so that employees at that level actually feel that their salaries are

better compared to the salaries offered by the competitors and hence work with motivation.

Communication channels

Mainly there would be two kinds of communications that had to be announced to all the staff

members in the organization. Firstly on those days when the organization makes good profits

and hence announcement for distribution of sweets as a gesture of celebrating the profits.

Secondly whenever there is a declaration of holiday or shutdown of the lab, then there would

be communication to the entire staff. Basically to communicate this kind of messages, they

issue a notice to all regarding the same. Other than those two kinds of announcements, mostly

the communication that happens are departmental specific and are communicated within the

particular departments.

Decision making in the organisation

The decisions regarding the procurement of new machine in the lab, collaboration with

doctors to setup a lab, strategic decisions and financial decisions are usually taken care

directly by the CEO himself whereas decisions regarding shift allocations among employees,

effectiveness and efficiency of machines are taken care by the respective department heads.

There would be discussions with the employees regarding their opinion and suggestions to

take a decision but that was just for the sake of making employees feel that their decisions are

valued in the organization. But in the end the decisions are taken by the CEO himself no

matter what the employee’s opinions were. Making the employees feel included and valued

in an organization is really important as it will induce positivity in the minds of employees to

work more efficiently and improve the productivity in the organization.

Consumers and Customers Satisfaction

In this organizations, customers are the doctors who prescribes or recommends the patients to

take the tests. Consumers are the patients who comes directly to the lab without reference

from any doctors. 80% of the turnover is from the customers and 20% of the turnover is from

the consumers. The contacts and connections with the doctors were maintained by the

marketing team and they were given the task to make connections with a number of doctors

so that the recommendations of patients increases which leads to the increase in the overall

turnover of the organization. Also there is a customer service team to handle the grievances

of the consumers. The efficiency of the customer service depends on the way of treating the

customers in the call and the amount of wait time to respond. Customer support is one of the

crucial aspects for any organization hence maintaining an effective customer support is a

must. In order to make that happen, the implementation of IVR systems will be helpful as it
would enable us to keep the track of response time and quality of service provided by the

customer support team.

Team Outings :

Outings :

They did use to organize occasional picnics for the employees across departments, but it did

not work well for them for mainly two reasons. Firstly, they needed to shut down the lab

which is working 7 days a week leading to loss of business for them. Also, there is threat for

reputation loss for the company because when a patient visits the lab on such day then he

probably would not consider visiting again. Secondly, the main objective of such outings is to

mitigate the interdepartmental conflicts and politics that existed and enhance harmonization

between them. In order to achieve that, the management involved the teams in sports

activities like cricket, etc but that wasn’t favorable as it resulted in increased animosity.

Instead of this, they should have focused on conducting some activities that would focus on

achieving the common goal to foster cohesiveness.

Cultural Values

The company has many stories about its history and background. These have been getting

published in the media like newspapers and some online news platforms. These
During festive days, when they make great revenue in business (approx. 6-7 lac per day), they

celebrate by distributing sweets in the organization. The notices are put up on the soft boards

with descriptions of the achievements of the organization. (example winning health awards)

Non-Uniformity in Providing Services

The service industry is heterogenous, they do not have a fixed daily schedule. The service

experience of the consumers is dependent upon the service providers, which due to

availability issues keep on changing. Also, the people come from different background, from

various educational institutes, and with different values and belief systems which affects the

kind of service that they provide. Some people might be hence kind and polite while some

might be difficult to handle. Similar is the cases in the supply side hence uniform services

cannot be delivered. Unplanned activities hamper with their normal routines is also one of the

reasons for this.

What they are missing on is a standardized service blueprint which will help guide the

employees to deal with different kind of customers and consumers. The employees must

understand the importance of basic etiquettes like greeting the patients politely when they

arrive.

They do not have a fixed number of people to attend the patients at the reception. They

transfer patients to another floor as well when they are more than fifty. They have another

reception on the second floor as well. Hence, they offer high flexibility and can handle

situations with large number of consumers easily.

Achieving the Vision and Mission of the Company

The vision of the company is to be the topmost diagnostic service provider in south

Rajasthan. Their mission is to provide quality services with their staff and high-end

equipment and resources. They do not purchase their machines for two reasons. They are

expensive and because the technology will get obsolete in a few years and they will need to

buy new machines. So to stay updated with the latest trends in the market and to stay ahead

of their competitors they buy the machines on lease. They follow the Industry Standards as

stated in the National Accreditation Board for Hospitals & Healthcare Providers to provide

the best quality of services with the most advanced equipment and qualified staff.

Although it was observed that they have not put up their mission and vision officially

anywhere in the workplace. When asked about the reason for the same the manager said that

he believed that one must be a graduate from a good institution to understand the significance

of it and imbibe these values. But the justification given did not sound reasonable for it

seemed necessary to display the company’s vision and mission in the organization.

One’s behavior is governed by one’s belief system. The people that work there, mostly

believe in destiny rather than hard work. They believe that no matter how hardworking they

are, if something is not written in their destiny, they will not achieve it. If they get an

increment or if they get fired, they will hold their stars responsible. They do not take up

ownership for their duties an Also, they cannot think ahead and are focused on just

completing their individual goals for the day. They are not much affected by the company’s

aims and goals.

Recruiting the people in the organization

They focus on the skillsets of the persons while recruitment rather than their culture and

values that they own. It is because they have observed that when they recruit people who are

good with words, when they join the workplace, they are not that skilled. On the other hand,

even if a person may not have good communication skills, they are found to be dedicated and

committed towards their work. Therefore, they focus more on their competency and

qualification which is the demand of their jobs. So, they hire them first and observe them for

15 days after which they can choose to fire them if they don’t find the employee job fit.

Competition in the market

They also face a lot of competition; mainly due to the government policies. This is one of the

reasons why the CEO feels that the company has not achieved much growth in the past 4-5

years. ‘Bhamashah’ is one such policy where the government gives almost free services to

the underprivileged section. They’d charge them approximately Rs 200-300 to provide them

services worth up to 2 lakhs. These patients do not visit the lab, but go to the government

hospitals, which have their own labs, to avail such services and can even get their insurance

done. Hence, everybody in this chain is benefitted, but is a loss for the organization in terms

of losing potential consumers.

Rewards and Punishments

Desirable actions as stated earlier, are rewarded in terms of bonuses, increments and other

variable benefits. Undesirable actions are also punished similarly. The doctors and other key

persons are sensible enough and they understand even if mildly warned. For lower level

employees, their salaries might get deducted, because that is how they will understand,

according to the manager. They are hardly motivated or demotivated by anything. For

example, if in a month, a person is arriving in late for ore than three days, his or her one day

salary is deducted. In case of major blunders, they try to recover the test money from the
employees. But these only happen in extreme cases if the employee is making the mistake

consistently which is rare. For example, in case of Vitamin D test, which is expensive

(approx. Rs 6000), if the employee exchanges the barcodes on the test tubes, they will have to

bear the costs. In such a case, they will go through the recordings from multiple cameras in

different locations to solve the issue. But again, these cases are rare because systems are very

much in place. So with basic warnings, the improvement can be seen. So is the case with

financial penalties, but there, the employee becomes dissatisfied. According to the CEO, a

dissatisfied employee in a service industry, is a terrorist. So, one must either satisfy him, or

get rid of him. Hence, they avoid these kinds of actions and with a little bit of scolding and

warning, try to improve him.

Artifacts

The males wear maroon shirts and pants with the company’s logo. The women may choose to

wear sarees or suits with the company’s logo. If in case they default, they must wear the

apron at least. They also wear id cards with the uniforms. They must wear the uniforms on all

days, even on festive days, to seem reliable and sincere.