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Corporate Social Responsibility: A Competitive Tool for Corporate Excellence^∗

Venkat Changavalli

The Emergency Management and Research Institute (EMRI) has been selected as one of those social innovations that have a global potential. This corporate social responsibility (CSR) initiative of Satyam has, thus, become an innovation project.

For the last 15 years of my career as a CEO, I have been experiencing conflicting demands made upon me from various groups. Customers want prices to be down, employees want their salaries up, vendors want their prices up, the government wants more and more taxes, and society wants something for the public good. Now, if each of these stakeholders place such demands on you, how do you really balance these conflicting interests as a CEO and still make the organization prosper over a long term? That is the demand on the leadership. According to me, governance, ethics, and CSR boil down to what kind of leadership you have. I always cite the example of Professor Ravi Mathai, who was the first director of IIM Ahmedabad. The institute became functional in the early 1960s, and the fact that it is flourishing even after 45 years testifies to the impact of the leadership provided by people like Professor Mathai. As the story goes, the then President of India rang up the institute and said that he wanted admission for his grandson. Instead of letting the admissions chairman take the call, Mathai spoke to him directly and said that if he received this kind of call the second time, he would let the press know about it. He said that if the grandson had done well in the test, he would get in, otherwise he would not. I think that kind of responsibility ensures that the institutions will be there for years. I am sure that the Loyola Institute of Business Administration (LIBA) is one such institute, and I am very proud to come back here.

CSR at Satyam is a competitive tool. CSR is not forced by anybody, and is not a legal obligation. It is something you want to do voluntarily, because you owe it to the society. We, at Satyam, believe that we owe it to society and are committed to adding value to our social responsibility initiatives. We do it through institutions. One such institution is called Satyam Foundation, the second is called Byyraju Foundation, and the third is called EMRI. I am the CEO of the third one. We have two separate CEOs for the Satyam Foundation and the Byyraju Foundation. The three of us meet once a month at the CSR council.

THE EMERGENCE OF EMRI

I joined EMRI on 15 April 2005. It took us four months to identify our initiatives, who our customers would be, what technology to adopt, what infrastructure to build, what people to recruit; and we finally went live on 15 August 2005. The phenomenal contribution we got that day was from the Ministry of IT and Communications, which gave us one single number. The President of India came to launch the scheme in Bhimavaram.

EMRI was set up basically to transform emergency management in the country. Today we are covering 50 towns in Andhra Pradesh, and we have completely covered two districts—Medak and East Godavari. By the end of May 2007, we will be covering all the districts of Andhra, which means the entire population of eight crores will have access to emergency services. Today, we are covering a population of 3 crores with 102 ambulances.

I just want to tell you what emergency is. First, we shall learn what emergency is not. It is not disaster. If it comes with notice then it is not an emergency. A dead body is not an emergency. An emergency situation means that there is a threat to life. A life is threatened either by a medical condition or by a loss a property or if there is something like a fire or an accident. All of these are instances that happen suddenly at the individual level. So an emergency is not the type of disaster that happens to tsunami-and flood-affected people. Those are hundreds and millions of people getting affected by natural calamities. In an emergency situation, it is what happens to an individual at his house or on the road, and someone has to render help to him. And 80 per cent of these emergencies unfortunately happen to the people at the ‘bottom of the pyramid’. In such emergencies, you do not have to call the police; you have to call a medical ambulance. It is not your problem to find out who caused the trouble. As an individual, you need help from one source. That is the basic idea of an emergency. Today, we are losing 50 lakh lives every year due to emergency situations in the country and every day people face 2,00,000 medical emergencies; in road accidents alone we lose around 92,000 lives every year. Tamil Nadu is number one, and Andhra Pradesh is number two when it comes to instances of road accidents. And more importantly, 80 per cent of such casualties happen in the first hour of admission in the hospital simply because we often delay it. I was once standing in front of CMC, Vellore at nine in the morning. I noticed that to address all the emergency-related problems that had happened at night, people wait till nine next morning, and this is because they don't have a telephone number to call or access to any mode of transportation. Twelve hours of golden time is gone and almost 80 per cent of the patients die in the hospitals. What is the answer to this? There is no legal framework. There is nothing called an ambulance. If you know how to ride and reverse a vehicle, that becomes an ambulance. Should it be a three-wheeler, a two-wheeler, a four-wheeler? What should be there in an ambulance? Four tyres or three tyres? There is no law. There is nothing like creating a hospital, there is no existence of a term called pre-hospital care. You only think that the doctor has to be there to treat you at the hospital. You cannot imagine that there is something called pre-hospital care and you do not know what an appropriate hospital is. All this led to an urgent need for transforming this country, to this emergency management.

I always say that nobody has lost eyesight till now by looking at the brighter side of things. We always lost eyesight by looking at the darker side of things. Why do we not see the brighter side? Is there a leadership in this country? Is there innovation in this country? Is there technology in this country? Can we synergize leadership innovation and technology? What we call synergy is the effort to transform emergency management in India. So what is new now? What is new in EMRI? The name itself is new. Emergency management is the first part, research is the second part, and the institute is the third part.

In America 911 is emergency management, but they do only one part, that is, taking the calls. Ambulances are sent separately by the Emergency Medical Services (EMS). But here we thought we should do all the three under one umbrella; end-to-end responsibility of taking the call to sending the ambulance and emergency management. Second, we thought why should we face emergencies if can we minimize them? Can we do some analysis? Why do 60 per cent of the week's emergency situations occur in Karnool only on Thursdays? Why is the number of road accidents maximum in Kokatpalli, Hyderabad? We have the data of 1, 82, 000 emergencies that tells us why are they happening. Why women in the age group of 14–49 commit suicide in the ratio of 1:2? Men two and women one is the ratio. We are building this kind of data to do research and help people to come out from the emergency in a faster and better way. And lastly, we thought the institute should focus on three things. First of all, we thought we should train people in what they need to do in the first 15 minutes at home before the ambulance comes. Can they stop the bleeding? Can they do cardiopulmonary resuscitation (CPR)? Second, we have to train the ambulance staff. We are starting a two-year postgraduate degree in pre-hospital care for the B.Sc. graduates with Stanford collaboration. Third, we are starting a course for the doctors on emergency medicine. These are the three levels at which we wanted to do it at the institute. Nowhere in the world are these kinds of things, at three levels of emergency management, research and institute, done under one umbrella, that too by an NPO. An organization has to be in line like an organization. I have 422 metrics to monitor. I have 108 critical measures to monitor every month. On top of it, throughout the world only public entities run emergencies. The police run it or the fire services run it, but never a private entity. This is the first time in the world that a private entity is coming forward and doing it in association with the public authority so that the synergies can be brought out from public resources with private systems and private leadership.

On the right side, that stout person, he is my customer. He is in distress, he is in pain, and he wants help. He is asking for help. ‘Please do something for me’, he seems to urge. But he cannot talk, he cannot cry, but he does not bleed all the time. In most cases of emergency, there is no bleeding other than in the traffic accidents. But still you have to care for him, you have to respect him. But do not put him above your head. You have to put him slightly above, next to you so that you understand him, listen to him better. The golden days of treating customer like a king is gone now. Treating him like a king means you cannot ask him questions to understand him. To understand a customer, you have to ask questions. If you treat him like a king, he will treat you like a queen. So, instead of that kind of relationship, you must have an equal relationship so that the customer understanding becomes better.

EMRI'S REVENUE MODEL

Now what is the business model? Our business model is that we are not collecting any transaction money from the customers—absolutely no money. When the person is in distress, he is bleeding, you cannot collect from him Rs 500, Rs 700, Rs 1,000. Even the Government of Andhra Pradesh was collecting payments till now. They used to take the ration cards. They would keep the ration cards with them till the patient paid the money. We said that it is nonsense and that we will not collect any money. The person is in distress, we will try to collect money from some other route, but not charge him. Now everybody was concerned more than me, who happens to be the CEO. What is our revenue model? Everybody is bothered about my revenue model. I said for two years, we have been given Rs 50 crore by the foundation. Now, the Government of Andhra Pradesh has come forward and said that in two years time, may be in less than two years, they will provide us with funds. The Andhra Pradesh finance minister has said in his budget speech, ‘I will give Rs 25 crore to EMRI to make sure all the rural villages are connected free of cost’. The central government has come forward and given us Rs 20 crore. When they heard this, the Madhya Pradesh government came forward and asked me, ‘Why don’t you start this in Madhya Pradesh?’ For these kinds of things, you cannot wait for a revenue model first. You have to build credibility and reliability first. The money automatically comes later. What the Satyam leadership believes in is the business model called Technical Direction Corporation (TDC). So, you first think before you do anything; then do it, then communicate what you have done. Unfortunately, what many people do is that they communicate without doing anything. So far what people were doing is they communicated what they have not done. Secondly, many people do not know how to communicate what they have done. We have these two extremes with us. I do not want people to pose around and talk using big jargon. On the top of it, problems are opportunities, problems do not go away, there will be problems everywhere, and particularly as NGO you will have far more problems. Moreover, you should know how to ask a million questions, leverage the knowledge that is available. We do a lot of this virtually and more importantly we seek to know how to improve continuously.

HOW IS EMRI MANAGED?

The next model is what we borrowed from Peter Drucker's writings. For managing an NPO, there has to be leadership. I have around 50–60 leaders reporting to me and to others. To me, there are 13 people and the rest report to them. Leadership of the highest level is required where the leaders are responsible for performance. Strategies, particularly marketing, are not a sin in an NPO. I have to market this programme. Probably 108 and EMRI have become the leading brands in Andhra Pradesh. No other NGO has gone this far in brand rating in two years’ time. The important strategies are marketing or innovation or fund development. We have to define what performance is. I am working for a cause and for that questions have to be asked. Why have you not gone there in 34 minutes? Why did you take 36 minutes? Why did you not answer the calls in two rings? This kind of performance measures are defined and measured, and told to them. There are many people who lost jobs. As I sacked people in the corporate world, here also I sacked people who had not met the performance measures continuously despite the training and development measures. More importantly, people relationships are not for people inside the organization. I have to relate to people outside—police, government, hospitals. How do I relate to them on a sustainable basis? On the top of it, for individuals who come here to work, there is no career. They are giving up their important jobs and coming here. What do I contribute to develop them? Every month I take three sessions—one for individual development, one on strategy, and one on leadership—and I spend time with the people working with us. This is the business model that I was talking about. Then the revenue models come automatically. For all the business graduates, my message is this: do not think of revenue model straight away. Talk of this business model, then the revenue comes automatically. Now how the customer got benefited?

THE SIGNIFICANCE OF SELECTING 108 FOR EMERGENCY CONTACT

We've got one number now, 108, and it is toll free. We did our research and people have asked to make it a toll-free number. That's the first requirement. We made it toll free and then they asked, ‘Can I dial on mobile phone?’ Nowadays, everybody wants everything to be accessible from the mobile phone. We said okay. We connected all the 10–12 service providers. Now you can dial 108 straightaway, no need of 044 or 040. Till now we have received 44 lakh calls, on both mobiles and fixed lines. Many people asked me why I had chosen 108. The ministry itself was suggesting why not 112? Why not 911? But why should we copy 911? Why do we have to copy the Americans after 25 years? Why should we copy 112, the European number? We chose 108 because, we said, 1 + 0 + 8 is equal to 9; it is a kind of lucky number. So, dial this number in case there is an emergency. Save somebody's life. As we went along, we found many more stories. For mathematicians, when you multiply 1 to the power of 1, 2 to the power of 2, 3 to the power of 3 you get 108: 1 x 4 x 27. Then we found that when astronaut Yuri Gagarin, went into space, he orbited around the Earth 108 times. I am told at the end of the year, the Japanese chime the bell 108 times to overcome the 108 temptations for the next year. I do not know whether they overcome the temptations or not, but they do chime the bell. In Hinduism, Sikhism, and Jainism, rosaries have 108 beads. Krishna played with 108 gopis; Natraja danced in 108 poses. The Akshardham temple in Delhi has 108 golden cow faces in. That is how we are able to promote and make people understand that this number is important. For sports lovers, a baseball has 108 stitches. Then we went to the English alphabet. If A is 1 and B is 2 and C is 3 and Z is 26, the word attitude adds up to 100. I, therefore, told them that 108 is better than 100, it is at least bigger than 100. Then to the word friendship; we found friendship comes to 108—if F is 6 and R is 18. Then I asked people if friendship can happen between two people; two people have to love each other to make a friendship last. And love comes to 54; so if I love you, I am giving you 54, if you love me back, it comes to 54, and both of us together make 108. That is how the friendship begins. But in my salad days it used to happen, I used to love that dame, she never used to love me back, so there is 54 plus 0 is not 54 mathematically, it is zero. I do attach a lot of importance TO 108.

SELECTION OF AN IDEAL AMBULANCE

The next thing I had to think about was the ambulance. I thought there are thousands of ambulances. We have 5,000 ambulances in Andhra alone, but nothing that I could copy. So we took 350 pictures of ambulances from various countries and said we should design something different and unique. When the designer asked me what was important to me, I said safety of the customer is non-negotiable; the patient's benefit inside the ambulance is non-negotiable. I want to give something more. I emphasized the fact that here in India relatives travel with the patients. Relatives struggle, they do not want to eat there as they think that patients recover better automatically when they do not eat. I said, ‘See to it that the patients are all right in the ambulance, with air-conditioned comfort, give them mineral water, and give them seat belts. Such kinds of comforts are important for the patients and also for the relatives.’ Second, it should be safe to drive. When the ambulance is taking this fellow safely, and hits 20 people on the road, that is not saving a life. You have to ensure public safety. So find out what kind of braking system, what kind of lights, what kind of sirens, and what kind of public address system is needed. To design this, a medical team, an engineering team and also a patient team, sat together with the marketing team to ensure what is non-negotiable, what is interesting, what is different—these were the kinds of marketing concepts we applied and designed. We took four months to design the ambulance worth rupees 22 lakh. First we bought 30 vehicles and then 40 of them later. When are buying ambulances, we look at the interior, its air-conditioning, and five structures to meet different needs: automatic accelerator defibrillator, ventilator, extrication and tools. Apart from these, there is an oxygen cylinder which has to be secured safely, or otherwise the ambulance itself may catch fire. Oxygen cylinders are normally the source of second accident for the patients in the ambulance. You must have seen the cylinder hanging around in ambulance. Normally in one rusted ambulance, there is one rusted cylinder that falls on the patient while the driver is driving. We said let us avoid that part and keep this ambulance's oxygen cylinder tucked inside the driver's cabin. You do not find oxygen cylinder here, but the patient gets piped oxygen from below. We went in to check even the smallest details such as where the hook should be for the IV fluids; around 101 minor details like this.

AT EMRI SAVING LIVES IS MORE IMPORTANT THAN ANYTHING ELSE

I am happy to say that we have saved 7, 687 lives till today. In my previous job as a CEO, whenever I used to say that we grew by 26 per cent and the profit after tax (PAT) has gone up by 42 per cent, the board never clapped. They would ask ‘What about next year?’ But here from the beginning they appreciated the fact that 10 or 20 lives were saved or maybe just one life was saved. Saving 7,687 lives is something phenomenal. We want to save 1 million lives a year by 2010; that is the target. And where did we save? In road accidents, where the guy was bleeding, we stopped the bleeding, gave him oxygen, gave him IV fluids, and bandaged him. You know, when a body part is fractured, that part is immobilized, all this is done in the ambulance, 20 minutes before he reaches the hospital or in case of cardiac arrest, the defibrillator is applied and he is given Sorbitrate. That is the kind of support that is required. We meet people who try to commit suicide by consuming poison that needs to be sucked out with the suction pump. Or in case of a stroke, reversible paralysis is something easy to treat if only ambulance reaches faster. The patient becomes completely all right if you are able to take him and dilute the clot. In case of respiratory complications, a simple lack of oxygen can be fatal. Many diabetics become hypoglycemic. They die of hypoglycemia because they do not take the tablet, of if they do not eat. We ask them to take that tablet. We have five doctors in each shift. When you call the doctors they tell you what to do next 14 minutes, before the ambulance reaches. Meanwhile, the fits of epilepsy, seizures are happening continuously. Doctors give advice before the patient comes out of these particular conditions or other such conditions such as, pregnancies or abdominal-related problems, or snakebites, drowning, or electrocution. One man was drowning in a 22-feet deep unused well. This man, a watchman, was drawing merely Rs 2, 000 as salary. What we used in the ambulance was only a 50-rupee rope to pull him out of that well and the fellow is all right. Now, at night he is doing the same job and during the day he is promoting 108. Another benefit customers got is that 4.4 million calls that were made are independent of geographical limits. Unlike in other places, throughout Andhra you can ring up from anywhere for police help. And with their trustworthy response, the ambulance is available at your house in, on an average, 15 minutes flat and we take the patient to the hospital in 21 minutes and that too hassle free. On the top of it, we synchronize both private and public entities. There was a lorry driver who was hit by another lorry carrying rods and one rod went right through him. We went all the way from Suryapet to Hyderabad to save his life. In another instance, a train went over a guy's legs and he lost both the legs, but the patient is safe now. We could do this only by providing the vaccine, by cleaning the wound, by taking him in time to the hospital. We trekked one and a half kilometers to reach him. The guy who informed us was another passenger of the next train that was going in the opposite direction; it could have been suicidal attempt. Actually, nowadays, we are getting what you call in marketing—repeat customers. You know, this guy knows 108 will come anyway, let me cut. 108 come now. This lady rang up after the deadliest viper snake bit her and she is absolutely safe. We have done 60 deliveries inside the ambulance. By mistake in the last conference, I said 60 pregnancies and everybody piled on me.

HOW EMRI IS DIFFERENT FROM OTHER NGOS

What are the principles we followed that are different from other NGOs, other traditional practices? The first principle is leadership. Satyam leaders gave Rs 50 crore in cash and Rs 100 crore worth of property. They said money is not important, leadership is. Whether it is Krishna Palepu from Harvard School, Raj Reddy of Carnegie Mellon, Rajat Gupta of McKinsey, Tarun Das of CII, K. V. Kamath of ICICI, all these are the board members who virtually ‘chew me’ every three months for three hours. What to do in next three months? How should we do something better for the society? We found something different. You require a brain, you require limbs, and you require heart for this kind of NGO. The brain is sensing an emergency where it is, technology can help, and reaching limbs is basically an ambulance or a police vehicle or a fire vehicle. The heart is basically taking care of the patient during the first 20 minutes of travel. All these 36 minutes—from the time somebody dials 108 till he reaches hospital—were what we were able to execute with perfection. Throughout, there is a doctor available to talk to the victim, the victim's relatives and also the ambulance technician.

BENEFITS OF TECHNOLOGY USED IN EMRI'S EMERGENCY MANAGEMENT

Technology is fantastic as now we take every call on computer. No favours are provided by Satyam as a partner since every voice is logged now. Someone will call and say, ‘I am a CBI officer, I am getting late to a meeting, please send me your ambulance’. ‘Sir, your voice is logged now, is that okay?’ ‘No, no, sorry sir. I didn’t know this.’ So, the misuse of calls also got minimized with this voice logging. And we also use it next day in the morning to minimize some mistakes that we might have made. We use it as a training tool. Maps are there to locate exactly if you are saying Valmiki Nagar, 3rd Seaward Road, and there is a Singapore shop as a landmark. We have AVLT, what we call Automatic Vehicle Location Tracking equipment, in each ambulance. We locate the ambulance exactly as it is going in Hyderabad. Sitting in Hyderabad we know where in Vizag our four ambulances going, which one is stationary, which one is moving. This probably is the only NPO that implemented enterprise resource planning (ERP) as Oracle Financials. We cannot be alone; we have to have the government as a partner. Everybody dissuaded me when I came to take the job at EMRI. Do not leave this fantastic multinational you are working in. Do not join an NPO; you will have to deal with these government fellows and you will suffer. I never met a single politician or IAS officer in my life before joining this job, but I got fantastic support from them because they are also human beings. On top of it, we tied-up with 911 hospitals. Nine hundred private hospitals came forward to say we accept your patients free of cost for the first 24 hours, after that we charge them. They recover charges at times for the first-day care also, but that does not matter. At least they are not refusing the treatment when it is needed. Then we partnered with the US associations. We said let us learn from them and find out what they have been doing. When I went to meet them for the first time in June 2005, they refused to meet me. But, when they came here in 2006 and saw the centre, they said it was just fantastic. In 2007 they asked if we could go and address their people, and tell them what we are doing differently. Satyam, as a technology partner, developed all these features to ensure that we were able to tell the ambulance to move in three minutes wherever the ambulance was located. It does not matter if it is 700 kilometers or 500 kilometers. In the third minute the ambulance moves or a police vehicle moves whether it is in Chit-toor or Srikakulam. Please remember, this is infrastructure for an NGO. An NGO built like this because at Satyam, it is believed that if you want to do CSR, do it properly and not just with a half-hearted attempt. We spent Rs 15 crore on the building, ten thousand square feet for 75 people to sit—this is a call centre and I said it is a distress job, everyday they take the calls, they have to breathe, they should have a seven metre sight, they should see greenery, they should see the light; only then can employees be motivated to take the calls. People are the most important resource. When these recruiters came and asked me what kind of people you want, I said I want engineers, MBAs first. They thought you are not either of them, and I said that I am both of them: an engineer and an MBA but I do not want both of them. What I want is not mere qualifications, what I want here to work in an NPO is someone who is committed, somebody who is hale, somebody who is resourceful, somebody who is empathetic. Our people went and selected about 15–16 employees. To get them, my success rate is 4.6 per cent. We have a seven-step entry process that looks for things like these: Can they speak three languages? Can they listen? They should not interpret and they should also be empathetic to patients. This guy who gets into ambulance, he should not say ‘enni ponam sir ponam’ (you are not going to stay here). He should say you are going to be alive instead of saying you will die soon. That kind of positive approach is required and sometimes callers ring up and you hear a male voice saying, ‘I am pregnant.’ You cannot say he is wrong; you didn't hear properly. Or perhaps he said, ‘My wife is pregnant’ but you didn't listen. So do not try to interpret him, no man with his self-esteem will ever ring up and say I am pregnant. You have not heard it properly. Same way, a guy ringing up and saying I have a right-side heart attack. Nobody tells you that, he just got confused between right and left or it could be gastritis, but you are nobody to interpret. The doctor decides what it is, not you. That kind of attitude is extremely important.

FRUITFUL PRIVATE-PUBLIC PARTNERSHIP

I told you about research and training. We have around 70 researchers. We are recruiting MDs and DMs to do research. We are recruiting research team to ensure that research continues regarding emergency, and also in relation to crime, and that we do the research and publish our results. So what is the road ahead now? So far the results are fantastic, 50 towns are covered. What do we do next? A government VIP came forward and said, ‘So far, Satyam was doing it, now we want to join. We want to give you these 310 ambulances in the first stage, 120 in the second stage, within one month.’ We signed a memorandum of understanding (MoU) with the finance minister and in four months the chief minister came to our campus and launched the 310 ambulance scheme with the health minister, and in less than one week we launched the service in the first district, Medak, and in the following week, in East Godavari. Now in the next four months, we will cover entire Andhra Pradesh. Eight crore people will have 500 ambulances. So by year 2010, the entire country will be covered. In six months, I think the first state we go to will be Madhya Pradesh and then later on to every state. We had a meeting with the prime minister. We made a presentation to the Planning Commission and we are working on the modalities of how the state governments, the central government and private partnership can work together.¹

WHAT IS THE ROAD AHEAD?

EMRI as a model agency can save 1 million lives a year by taking 1 million calls a day. Three people out of every ten, rings for one emergency once a year and it comes to 1 million calls a day. What kind of competence do we have to build? Fifty thousand people have to be employed, 8,000 ambulances have to be deployed and we have to train these 50,000 people on the soft skills and also in technical skills. And from where do we fund this ambitious project? Ultimately, it comes to only Rs 10 per person per annum. Instead of charging him 10 rupees, let us find out sources from somewhere else rather than asking the victim to pay for it. Ultimately, we in India do not have to go to one of the developed countries. India cannot become an automatically developed country unless we know how to respect a life, how to value a life, how to care for a life. Those countries that became developed countries, knew how to respect a life, how to care for a life, how to value a life. That is the genesis of GDP, manufacturing services, all else is secondary. If you know how to respect a life, get it reflected in value systems, and that in turn, gets reflected in your GDP. These are only the tools. To achieve this, what is required is that people like us show greater humanitarian concern, inculcate little more humility, and lastly, display little more commitment to serve other people, rather than leaving that commitment only to the bureaucrats and politicians. If this happens, I am sure our country will be one of the top 5 nations in the world by the year 2020.