The Tokyo Foundation for Policy Research


The Tokyo Foundation for Policy Research

Ambulances for India: (6) India

November 8, 2011

Activity Report

In early spring 2011, Dial 1298 (Ziqitza Health Care Ltd.) was preparing to launch a 90-vehicle ambulance service in Punjab as a public-private partnership project with the Punjab state government. In March and April I was in Amritsar, Punjab, for three weeks leading up to and four weeks following the launch (sandwiching a week in Nairobi for the Acumen Global Fellows Fund midyear meeting). I found myself smack in the middle of the flurry of activity (or perhaps the flurry of confusion) during those weeks as a key member of the Punjab project.

Indian-Style Communication

The biggest challenge in the run-up to the official launch was to keep the whole process moving according to plan while coping with a rapidly expanding roster of new faces. This sort of undertaking would have been difficult enough in Japan, but having to work in India posed a completely different set of challenges for me.


I had worked with Indian partners in the past, but such experiences were hardly enough to prepare me for what I would face. Given the severe time restrictions, I was moving and talking faster than I could think, and I found myself being rather brusque with the people around me. It wasn’t long before I ran up against the first of many walls with our new Punjab team.

Saying something once was not enough to get people moving, even when the request was made in a clear and explicit manner. It was as though no one was even listening.

I sought the advice of Ziqzita’s CEO, who is about my age and was born and raised in India. I’ve seen her yelling instructions to her staff and losing her temper on the phone with business partners, so I’d taken for granted that she was a hot-blooded person. But she told with a laugh that she wasn’t always this way. “I’ve been doing this out of necessity since becoming CEO.”

Getting people to do things was difficult even for someone born here, requiring her to adopt a brand new persona. Learning this made me feel a lot easier, and I told myself that if she was able to learn and adapt, there’s no reason I couldn’t do the same. From then on, I stopped feeling the need to be polite and focused all my communication energies on getting the job done.

1. You Must Ask to Get What You Want

In fact, you’ll probably need to ask repeatedly. I often waited to be informed that some task I’d assigned was finished. I was hesitant to ask for an update, thinking that I’d be rushing the staff or that they were busy with other tasks, but I found that in 9 cases out of 10, the task had simply been neglected, and no progress had been made.

When it comes to getting work done here, the old truism applies all the more: A phone call is better than email, and a face-to-face meeting is better still. In practical terms, that meant going back and forth between the two Punjab offices, sometimes many times a day. If I hadn’t made that effort, important work would simply have been left undone.

2. Anger Can Command Respect

The amount of pushing needed to get work done here would be regarded in Japan as being poor manners (or worse). There’s a need to shout, “You said it’d be done by today, why isn’t it? Do it now!” I still do make an effort to be respectful of others’ feelings, but that doesn’t seem to be appreciated very much.

This is especially true for the rank and file. It’s important to be as direct and blunt as possible at the outset and make adjustments as time goes on. Making yourself clear early seems to send a message that they’re going to have to listen to you. In Japan, workers will normally try to meet 100% of what they’re asked to do, but in India most workers—and companies too—seem to consider 50% to be enough at the outset. Only when they’re pressed will they make the extra effort to reach 60% or 70%.

3. Asking the Right Questions

Employees rarely tell their managers that an assignment can’t be completed, even if they know it just can’t be done. Time and again I found myself lamenting, “If they’d only told me at the outset, I wouldn’t have had to adjust the schedule and could have avoided this mess.” Workers do so much talking here, but they hardly ever argue with their bosses or offer alternative proposals.

When asked “Can you get this done by Monday?” the staff will routinely say yes, simply because they don’t want to say no. So to get around this, I learned to be more specific, asking “How many days will it take to do such and such?” “What will you have to do next?” “And how long will that take?” Using simple arithmetic then reveals that it would be impossible to complete the task by Monday. Only then will workers admit—without being the least bit contrite—that the Monday deadline cannot be met.

This phenomenon was admittedly quite stressful for me. Even so, it taught me how I could improve the quality of my questions, instead of just trying to “fix” other people.

Differences in Learning Styles


During this time I also served as the training coordinator, planning programs for the new staff (about 200 drivers, 200 paramedics, 50 call center operators, and 15 field managers), as well as creating schedules and arranging for training facilities. I also led some of the courses for the call center staff and field manager myself and quickly learned some differences between my own learning style (which could probably be called the typical Japanese learning style) and the styles of our Indian staff.

In Japan, it’s a given that students would bring a pen and paper to class, but here not even the managers brought note-taking materials with them. I wondered how they expected to remember anything without taking notes, but I found that they memorized facts by repeating them aloud.

In an effort to be absolutely sure I was understood, I initially explained everything as thoroughly and from as many angles as possible, but the response was rather poor. I didn’t realize my mistake until I later sat in on a class by another trainer. The shorter the explanation, I realized, the better.

The most important part of the process was to get the trainees actively involved. The teacher would ask, “What should a paramedic do in this situation?” and everyone in the class would respond loudly and in unison, “Give the medical certificate to the doctor!” Asking the trainees to explain what they had learned in their own words and as often as possible seemed more effective.

How Good Is Good Enough?

To install the best and latest IT infrastructure in the industry, Ziqitza created new software for the call center and ordered new in-vehicle ambulance GPS terminals. Since I had been involved in a software development project in the past, I was placed in charge of this facet of the project as well and worked with people inside and outside the company on a daily basis.

As the planned launch approached, my stress levels kept climbing. Shortly after the official launch, when I returned from the week-long Acumen meeting in Nairobi, I was infuriated at the lack of progress. I was appalled to find that operations had begun under truly slapdash conditions. This was simply unthinkable for me.

It was only later that I realized that I had been trying to apply Japanese standards. I had been accustomed to making sure preparations were 100% (or 90% at the very least) complete before launching a new venture. In Punjab, though, things began at around 50%, and only over the next four weeks did we manage to raise the level of preparedness to around 70%.

In a multilayered Indian company with a sharp division of labor, different levels of worker skills, and a vaguely defined management structure, expecting everything to proceed according to plan is unrealistic. Under such circumstances, it would be mentally healthier to accept that “100%” just isn’t attainable. It would also lead to more appropriate management decisions.

India has a rapidly growing economy, so even if a decision isn’t perfect and even if preparations aren’t 100%, any effort is bound to produce results of one kind or another. Even if an attempt flops, the consequences aren’t likely to be disastrous.

This is not to say that the tireless pursuit perfection seen in Japan is not without its merits. Japanese companies can credit this business approach for their many global successes. But it’s important to keep in mind that such standards are not always applicable to places like India.

I remembered a piece of advice that I received just before leaving Japan from someone well acquainted with India: “I’m not going to give you the customary ‘ Ganbatte ’ (do your best) send-off. In fact, my advice to you would be, ‘Don’t try too hard. Do only what you can.’ Rather than sprinting along at full speed, in India you should slow down to around 70%.”

I should probably give up all thoughts of trying to control everything. India is a vast and (at first glance) disordered country that will mercilessly expose your limitations. You need the humility to accept those limitations and to jog along at 70% of your strength in order to go the distance. Otherwise, you could wind up tripping into a bottomless swamp.

As I reread this update, I realize that these revelations aren’t necessarily peculiar to India. They are just as true in Japan as well, although there are differences of degree. I have to stop blaming India for my problems; I would probably encounter them anywhere I go. This is a lesson that will stay with me no matter where I go.

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

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