The Tokyo Foundation for Policy Research


The Tokyo Foundation for Policy Research

Ambulances for India: (3) India

October 7, 2011

Activity Report

I spent the first two weeks of my time with Dial 1298 in orientation and learning the ins and outs of ambulance operations in Mumbai. I spent every day riding along with the ambulance crews during dispatch and taking patients to medical facilities or observing operations at the call center where calls were taken and ambulances contacted for dispatch.

Not long after my arrival, I began work on my first major project: developing a standard operating procedures manual. Dial 1298 provides ambulance services in three states. By creating precise and specific standards for company operations in all locations, Dial 1298 would be able to ensure higher quality service and reduce the time required to start up operations in a new city.

Dial 1298 is currently preparing for the start of operations in the state of Punjab. The task of creating the SOP manual began with visits to each of the three current operating centers in December. I spent one week at each facility to survey operations and conduct interviews.


I spoke with workers assigned to nearly all of the company’s primary functions, including call center personnel, ambulance field staff and their managers, maintenance workers, those in charge of medical supplies, physicians, IT staff, personnel department staff, and accounting staff. I was the only person working exclusively on this project, and I reported directly to the CEO.

Lessons in Leadership

In my previous work at a consulting firm, I had gained considerable experience with projects involving staff interviews and operational planning and improvement. Even though I was in a different field and in a different country, I felt like I had a fair grasp of what I needed to do from the outset. One of the core objectives of my field assignment in India was meeting with as many people as possible. So this project was the perfect vehicle to achieve that goal.

Although I was familiar with this sort of work, I realized there would be no personal growth had I simply repeated what I already knew. So I made an effort to apply the leadership lessons I learned in New York to my work in Mumbai. I think three lessons in particular were of great help to me.

1. Be Personal, Be Vulnerable

In New York this message was stressed over and over as being the key to effective leadership. I thus made a conscious decision to be more open and personal, instead of being narrowly task-focused, which had been my normal mode of operations.

During my conversations with employees I allowed myself (more than usual) to ask about their lives outside of work, inquiring about their families, hobbies, and hometowns. I shared stories about myself as well. And I found that trying out the few phrases in Hindi that I’d learned was a surefire icebreaker, considerably narrowing the distance with the employees. Conversations always went smoother afterward.

2. Prioritize People, Even If It Means Compromising Quality

The interviews I conducted were limited by the available time and human resources. I was working alone and was stationed at each operation center for only a week (which left, at most, five-and-a-half or six days per center, since a full day or more was required for travel). Just making an inquiry into and recording the most crucial information was all that I could do. Gathering information wasn’t my only goal, moreover; I also wanted to find colleagues with whom I’d be able to discuss the SOP—even when I couldn’t meet them in person—and who could be counted on to apply and continuously improve the manual.

Creating a perfect document is not enough to fulfill a proper leadership role; it is also important to persuade people around you to take a personal interest in it and to apply it in practice. I therefore took every opportunity to share tea with workers and listen to their stories—sometimes late into the night—even if this meant losing time on the documentation.

To really understand the work, it is crucial to first understand the people working there. Because of my preoccupation with quality, I had a tendency to lose sight of this truth, especially when things got busy. The real fruits of the manual may not appear until much later, but I think it has already made an impact. I hope to keep abreast of how it evolves from now on.

3. Issues in Scaling Up

The reason I hoped to meet as many people as possible during my time here was that I wanted a firsthand understanding of the kind of people who are attracted to a social business in India. What kind of education, skills, and motivation do they have? What characterizes their working and management styles? Who are the directors (founders), the managers, and the field staff?

During my first few weeks in India I was able to see for myself how the company trains and remote manages the drivers, medics, and other ambulance staff. A small operation like Kerala with 25 ambulances is easy enough to oversee, but the 189-vehicle Rajasthan operation is not so simple. There were workers who claimed to be on a call but were really slacking off, and some would suddenly stop coming to work altogether. There was also the possibility that employees were ordering more fuel or medical supplies than was needed (and selling them off on the side).

I also saw that there were wide discrepancies in the extent to which the company’s mission resonated with the employees and was reflected in their actions. So while boosting employee morale with talk about the company’s mission and vision, it was also necessary to supervise their behavior through strict oversight. In a country like India, where education levels of workers can vary widely, and especially for a quickly expanding company like Dial 1298, there is an inevitable need to strengthen the supervisory aspects of management.

For the past few years, I have had the privilege of meeting many leaders who focused on the “mission” of their activities, and this is also the milieu in which I personally worked. Now, at Dial 1298, I was confronted with the need to approach management from the opposite angle that emphasized “control.” I’m sure I’ll run up against many walls in this less familiar terrain, but I hope to turn this experience into an opportunity for personal growth.

Concluding Thoughts

My first few weeks in India have been tremendously meaningful as a learning experience, since I hope to someday be engaged in a social business in a country like this one.

In January, I’ll be working with the leaders of each department in Mumbai to finalize the SOP manual, which is slated to be used in February for worker training and in preparation for the start of Dial 1298’s operations in Punjab.

    • Tokyo Foundation Acumen Fund Fellow, 2010-11
      Secretary-General, Gaia Initiative
    • Chikako Fujita
    • Chikako Fujita

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