The Narayana Sewa Sansthan (NSS) falls under the Hospital Activities group under the Human Health Activities division as per the National Industrial Classification. This division includes hospitals, private clinics and activities of Ayurveda, Unani, Homeopathy and other such professionals.
Several for-profit and non-profit organizations operate in this industry in India and the revenues from the industry stood at $ 30 billion in 2010 as per the report on Hospital Sector by Northbridge Capital in November 2010. India still faces a shortage of over 6,500 primary and community healthcare centers with the expenditure on health in India less than 1% of the GDP compared to more than 5% in the developed countries.
Narayana Sewa Sansthan
Narayana Sewa Sansthan is an ISO 9001:2000 certified NGO started by Mr. Kailash Agrawal "Manav" in 1985. Dr Kailash used to work in P&T department in Rajasthan and foundation of Narayana Sewa Sansthan was an interesting story which was a culmination of Mr. Agrawal's sentiments and kind heartedness towards fellow human beings. He along with some of his friends took charge to serve mankind and established Narayana Sewa Sansthan. NSS, at present treats polio patients, those with cerebral palsy, and orthopedically handicapped and disabled persons. NSS also provides vocational training and education to physically disabled and mentally retarded people to make them self-reliant and independent.
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This charitable organization closely works with hospitals, mental institutions, and institutions for the disabled. NSS treats disabled people free of cost and after that provides them education and training to enable them to earn their own livelihood. NSS boasts of highly trained professionals and volunteers in this noble cause. All these programs are made possible by contribution and donation provided by individuals, organizations, and corporations.
NSS has its office in Udaipur, Rajasthan, India, and at present it is running 13 hospitals for polio treatment and one international hospital for treatment of people from birth, free of cost. These hospitals have more than 1000 beds and state of the art facilities and surgeons for treatment of polio patients. It maintains a hostel for orphaned children and a residential school for the mentally retarded, blind, deaf and dumb children. NSS frequently organizes service camps in order to distribute food, medicines, and basic utilities in the tribal areas around Udaipur. It also organizes marriage ceremonies to tie the knots of physically disabled people and takes care of educational expenses of poor students who exhibit talent.
The organization has taken up several endeavors not only to treat the poor but to work towards their upliftment. It mainly focuses on the polio disabled segment and also caters to the physical, economic, and social rehabilitation of the disabled.
Physical endeavors- The organization makes sure that crawling polio patients can stand on their own feet by undertaking surgical intervention.
Economic endeavors- The organization has taken an initiative by creating facilities for providing training to the disabled in various professions and also conducts Vocational training centers. It has also provided raw materials and tools for aiding the training of disabled people residing in villages.
Social endeavors- The organization has put in serious efforts to organize marriages of the unfortunate disabled persons. It has helped more than 700 couples in tying the knot.
Service camps- It has taken initiatives to serve food to the needy and poor families and blankets and flour packets to the needy people in tribal areas.
Social awakening- The organization has taken initiatives and conducted to spread awareness about the danger of addiction among the masses. Also, it has maintained a mobile medical care unit which is equipped with all modern medical facilities.
Caring for the orphans- The Sansthan has been running an Orphanage named "Bhagwan Mahaveer Nerakshit Balgrah" and takes care of the food, clothing, and education related needs of children up to the age of 18. Also, it runs a residential school for mentally retarded, deaf, dumb and visually impaired children.
The organizational structure consists of a minimalistic organizational chart with only the very top positions being defined. The trustee and managing director is of course Mr. Kailash Chandra Agrawal. The president is Mr. Prashant ji Agrawal. Mrs. Vandana Agrawal, Mrs. Kamla Agrawal and Mr. Devendra Chaubisia are the directors (Exhibit 1 shows the organizational structure of NSS). Below them are the 18 department heads. There are departments ranging from hospital related to HR and even literature. People's roles are well defined especially in the lower rungs of the organization. On the upper levels there is not much hierarchy. An open door policy is followed and people can easily walk in and talk to the director and the president about their issues. This is true for each and every employee though it is mostly practiced by the department heads as they are more familiar with their superiors.
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The director has clearly attempted to create the maximum horizontal linkages possible but the lower level workers, due to ingrained culture, do not directly approach the director or the president. Thus we see that as far as the departments are concerned, there are well established horizontal linkages within them; information through this mechanism, once gathered by the Heads of Departments, is then horizontally conveyed to the directors, the president and the MD. Here again things are not hierarchal and horizontal linkages allow for information to pass from one to another in no particular sequence. The information at this level is again conveyed on a need basis and not in a bureaucratic fashion.
Thus the only linkage that can be considered formally vertical is that generally the department employees do not directly go up to the higher ups. However as the mechanism to bypass this exists, such an attitude suggests trust in the department and in their superiors. After all in case of conflict they can always approach the higher ups. Another direct impact of the horizontal linkages is that innovation and learning is easily encouraged. New ideas from employees are heard and implemented if found to be productive. This type of action is quite fast paced due to the structural design of the organization.
The best way to describe this organization is vertical structure with effective horizontal linkages. The culture created here gives a clearer picture as to why such a structural design was necessitated. The culture is such that the people do not have profit making motive, rather they are there to serve. Every worker of the Sansthan is called a "Sewak" or "Sadhak". Sewak is defined by the NSS as religious worker. The Sansthan does not have any clear religious affiliations, however thy have been visited by many renowned yogis, babas and tirthankars. The aim is to do Sewa in conjunction with the mission and the vision of the Sansthan. Therefore even the MD is referred to as Kalish ji Manav Sewak. The word helps in dissolving away hierarchy. It gives a sense of equality and fosters camaraderie among all levels of management and employees. Moreover it acts as a motivating factor that empowers the employees to work at the nominal wages offered and still maintain a high level of commitment.
Thus we see that there are no inter or intra departmental conflicts outright, the information flow in the organization is both vertical and horizontal. The organization has a familial culture, suggesting an organic structure; however it is mechanistic when concerning procedures. This is evident in the number of successful polio surgeries carried out for free. Till date more than 1,46,000 successful polio surgeries have been conducted here. This achievement has even put NSS in the Limca book of records. There is clarity of purpose in the mission of the organization and this gives an appropriate structure to the organization.
Within the organizational ecosystem NSS has not formed any collaborative alliances with other NGOs with similar goals. The reason is not the traditional adversarial approach but the fact that they perhaps do not want to share the success that they have achieved in garnering the funds from India and abroad. As the entire organization is based on donations and even the salary provided to the employees is also garnered through these means, sharing this kind of resource could lead to dilution of funds that could ultimately affect the functioning of the successful organizational model that has been established.
In India, NSS has more than 550 centers (as reported by Mr. Deepak Gupta HOD literature department) spread across 23 states and union territories. In the global scene they are deeply entrenched in USA. They have 13 offices in USA with a separate hierarchy (Exhibit 2 shows the reporting hierarchy in USA).While in India the primary focus is to serve, in the international centers, their motivations seem to be economic primarily and technical otherwise.
Secondly in internationalization there is a scope of transfer of knowledge and innovation in a two way process. Cheaper technologies could be provided to the U.S. partners(if any exist) and newer innovation from other countries could be integrated in providing better prosthetics and quality products to the people the Sansthan serves. These can be localized as per Indian needs and given free of cost to the patients coming to NSS. Later glocalization can provide marketing opportunities to other countries and selling these technologies can generate alternate streams of income for NSS.
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As far as interaction with the external environment is concerned the effects are felt chiefly within the government sector. Here we see that a number of awards have been bestowed on NSS. (Exhibits 3 and 4 list some of the awards and achievements of NSS). Along with awards of recognition there have been grants and monetary remittances paid to the Sansthan by both the state and central governments. Most recently, a donation of Rs. 1,00,00,000 was awarded to NSS and Jaipur foot together. This chiefly forms the means of interaction in the task environment. Apart from this, sociocultural, economic, and technology sectors affect the organizational environment.
The sociocultural backbone of sewa, if removed would result in the collapse of the whole organizational design upon which the Sansthan is now set up. If the world economy is in a recession the number of donations being garnered by the Sansthan would dramatically reduce. In case of domestic recession too this effect would be apparent. With a growth in inflation the cost of providing free services would increase and the number of people being served may reduce.
Technology too plays an important role in the external environment interaction scheme. Less than a month ago, bio-metric eye scanners were installed in the office in Hira-Magdi in Udaipur. This process is also being currently implemented in the hospital. All establishments of the NSS are kept under constant CCTV surveillance. These measures ensure timely breaks and attendance by the employees and the CCTV ensures a proper conduct by the employees. According to Mr. Deepak Gupta there have been instances of workplace sexual harassment and the harassers have been dealt with swiftly thanks to the CCTV's.
Internal Factors and Design
Category of Organization: The Narayana Sewa Sansthan (NSS), a charitable organization in the service sector, like other service organizations, accomplishes its primary purpose of serving the mankind through provision of services in the form of education, social and medical services. It is successfully running 516 branches in India, 111 branches abroad and 13 prestigious hospitals for polio affected patients which clearly say that it is a labor and knowledge intensive organization with many employees needed to meet the needs of customers. Also, since it mainly focuses on rendering philanthropic service to the society at large, a direct interaction between the customers and employees become very essential. Thus, a service organization like NSS uses few boundary roles because the services rendered by it are intangible which makes it essential for the customers to interact with the service providers.
The mission and vision of the organization is valued more by the employees than the salaries they earn and this is what keeps them motivated. There is neither a formal performance evaluation system for the employees nor is there a reward system but the employees receive gifts and sweets on occasions like Diwali, Dussehra, etc.
Interdependence among departments: The operating unit of Narayana Sewa Sansthan at Hiran Magri, Udaipur has eighteen departments including the Hospital department, Donations department, Audit department, Communication department etc. These eighteen departments have limited interdependence among themselves with each department contributing to the common good of the organization but working independently as in the case of pooled interdependence. Each of these departments share financial resources from a common pool and also, the success of each department contributes to the overall success of the organization.
Control levers used at NSS: NSS was established in 1985 with the mission of helping mankind by treating patients suffering from polio and cerebral palsy and also serve the disabled. One unique thing about NSS is that their mission has not changed in the last 27 years and will not change even in the years to come. To ensure this and keep the employees motivated to serve people, it has used belief systems to articulate the values that the founders wanted to carry forward with time. NSS's prime focus was to render philanthropic services to the society and therefore, it has intentionally designed belief systems to be broad enough to appeal to all the departments and their employees and also to inspire commitment to the organization's core values or mission. Without a formal belief system, employees in large organizations don't have a clear and consistent understanding of the core values and are forced to make assumptions about a lot of things and behave in a weird way to unpredictable circumstances. Belief systems in NSS helped the employees understand the larger purpose of their efforts, in other words to help them understand that they can make a difference.
New recruits and Payment policy: Currently NSS's operating unit at Hiran Magri has around 800 employees and the recruitment of new employees depends on vacancy. They have a unique payment policy wherein during the recruitment process itself the interviewer clearly mentions that the salary paid will not be very lucrative and that the employee should have an inherent interest to serve people and should give more importance to help mankind.
Transparency: All accounts are audited by certified CAs and the details of each monetary transaction can be looked up. Everything is documented and modern software is used.
Narayana Sewa Sansthan is a well-structured organization with fully functioning departments (Hospital operations, HR, Call center, Finance & Accounts, Auditing, International branches, Literature, Projects, etc.). All these departments are well aligned with the organizational mission and vision and all employees (called "Sadhak") are well aware of the mission of serving the oppressed. NSS has 13 international branches each headed by branch presidents. These branches play an important role in the fund management for Narayana Sewa Sansthan.
Since every department has a well-organized hierarchy, and are being represented by respective department heads, for the sake of studying the organizational process, we will be looking at Decision making, Culture, Conflicts and Innovation as the key attributes.
Decision making: All departments play an important role in the decision making process of Narayana Sewa Sansthan. Since Narayana Sewa Sansthan consists of more than 800 employees, active participation of each and every employee in the day to day decision making is difficult, but all of them are well represented by their respective department heads. Decisions are taken regarding fund management, ongoing operations, hospital management, future projects etc.
Decision making policy is quite clear and simple in Narayana Sewa Sansthan. A cabinet consisting of the managing trustee, the president, the directors, and all the department heads meets every Thursday to review the ongoing projects and gather updates from each member regarding their specific department. All issues (including delay in printing of literature, canteen related issues) are put forward and discussed. This helps Narayana Sewa Sansthan in eliminating cognitive biases in decision making, which arise from individual judgment. By arriving at a decision collectively or in consultation with several people in the organization, this risk is eliminated. But here in this process time taken to arrive at a decision is more as compared to individual decision making. Reaching a consensus is not a big challenge at NSS because they have an open door policy i.e. they are open to new ideas and follow an organic management structure. This helps in creating a friendly work environment wherein any employee can walk up to even the President, to have his issues resolved. The employees work in close collaboration which also helps in keeping them motivated. The problem of group think can dominate in this kind of decision making process which may seriously hamper the quality of decisions.
The final decision, which is usually unanimous, is approved by Sh. Kailash Manav, the managing trustee of Narayana Sewa Sansthan.
Culture: During our interview with personnel at Narayana Sewa Sansthan, we found that the culture of Narayana Sewa Sansthan is mainly driven by its mission of serving the oppressed. They called it a family culture which was evident from the way they referred to Kailash Ji Manav as "Babuji" and his wife as "Mataji". Even fellow employees were called "sadhak", which means people with a specific goal to serve, and this goal was to serve the humanity for NSS employees. The degree of social capital, the quality of interaction among people and the development of a common perspective is very high at NSS. In such kind of organizations, relationships are based on trust, mutual understanding, and shared norms. Here shared norms and values are the motivating factors for the people.
The culture of Narayana Sewa Sansthan is "Mission Culture" where specific customers in external environment are served. Narayana Sewa Sansthan is an organization where there is no need for frequent change. Their vision and mission have remained same over time and are unlikely to change in the near future. This kind of culture is based on clear goals and targets. At NSS, the targets in terms of number of operations performed in a day are clearly defined and the organization continuously strives to increase these numbers. Mission culture is characterized by professionalism, ambitions, and aggressiveness. These are all evident in Narayana Sewa Sansthan. Orthopedic surgeons (4 numbers) carry out approximately 90 operations in a day. This is a clear sign of professionalism driven with mission culture. NSS is expanding into a 1000 bed hospital in Badi (Near Udaipur), a sign of ambition to serve people in large quantum.
Conflicts: Organizational conflicts are a result of normal interaction of varying human interests. Three ingredients are necessary for intergroup conflicts: group identification, observable group differences, and frustration. Any missing ingredient will cause the triangle to remain incomplete.
In Narayana Sewa Sansthan, there are observable groups as different functions are organized into departments and reporting structure is well identified. A number of departments are placed on the same floor of the Ankur Apartments office (Hiran Magri Sector-4, Udaipur), yet some other departments like call center and hospital are at different places. This could cause some level of group differences.
Sources of conflicts in an organization are goal incompatibility, interdependence of tasks, differentiation etc. Here in Narayana Sewa Sansthan right from recruitment stress is given on the ultimate goal of service to the people. All people in all departments value this, and this has largely helped NSS in avoiding major conflicts.
Organizational innovation: Establishment of Narayana Sewa Sansthan itself was an innovation by its founder trustee. The basement of the hospital is used in preparation of calipers, artificial limbs and other equipment used in the treatment of patients. Capacity and space is utilized at its optimum level. Further, 90 operations in a day by 4 surgeons tells story of efficiency of the whole system. Since the number of people to be served is increasing by leaps and bounds, innovations to improve the efficiency of the operations are vital. Innovation is something an organization needs to foster to cater to the demand of a changing environment. Narayana Sewa Sansthan is doing a great job in treating people suffering from polio free of cost.
Issues: As per Mr. Dilip in HR, NSS faces a severe shortage of staff in HR and the payroll on an average takes about 10 days. Other problems include a lack of hospital beds and the greatest issue faced by NSS is that after the diagnosis or examination of a patient it could be up to two years before the patient is operated upon. As a large number of patients coming to Udaipur are from Delhi, their measure to deal with the problem is to start up operations in Delhi so as to alleviate some delay time.
Leadership at Narayana Sewa Sansthan
Leadership ability determines future success of the organization. Its founder, Mr. Kailash Manav, leads Narayana Sewa Sansthan. He considers NSS to be a family and not an organization. He is a role model for people working in NSS who call him "Babuji".
Mr. Kailash Manav believes in transformational leadership which aims to win the hearts and minds of others.Â It necessitates trust, concern and simplification rather than directly controlling the members of the organization.Â He wants people in the organization to have skills that establish a long-term vision and mission, and authorizing people to regulate themselves, coaching, and evolving others.Â He wants to create trust and understanding among the employees so that they can serve people more efficiently. Mr. Kailash Manav is a kind of leader who develops a spiritual energy within the employees of the organization that helps them to take positive actions.
Mr. Kailash Manav wants to help not just the poor and needy, his nature encompasses the benefit of the employees as well. He believes that by listening to the dreams, needs and desires of people best service can be provided. Narayana Sewa Sansthan organizes weekly meetings so that employees and patients can share their problems and needs. In addition, he is very approachable and any one can walk into his room and discuss the concern if required.
He is successful in influencing employees of the organization to work towards attaining a common goal. Cohesive behavior and cooperation among the employees play a very important role in achieving the organization's goal and he tries to infuse positivity so that everyone works together and the organization can reach the quantified goal.
Important practices followed by Mr. Kailash Manav
Providing purpose to the employees: According to Mr. Kailash Manav, vision of the organization is paramount, without which, people will not aspire to work towards achieving the common goal. People perform better, work cohesively, and sacrifice only if they are aware of what they are working for. Apprehending and cooperating vision is very important for the organization and he tries to portray the big picture. He wants to make people believe in the fact that each one in the organization is equally important and has a role to play and that everyone is contributing to the larger picture.
A star team should be built, not a team of stars: Â Individual development and preferences come secondary, Mr. Kailash Manav believes in development of the whole group. He thinks that if players are not willing to compromise on personal goals, then it is almost impossible for the team to reach its potential. He encourages his employees personally to become team players. He always shares thoughts of Ervin "Magic" Johnson that "Everybody on a championship team doesn't get publicity, but everyone can say he's a champion." People are encouraged to create a winning team by cooperating and thus everyone can be a winner. He wants to involve everyone in establishing shared values and create an environment that supports consistent team efforts, joint creativity, openness, and freedom to talk and trust. This kind of environment helps in resolving dysfunctional behavior, smoothen collaboration and encourage joint problem solving. This ultimately helps to capitalize the use of every team member's diversity.
Shared ownership should be created for the results: Mr. Kailash Manav inspires people to start work by themselves and then share own individual output with their groups. Eighteen departments are functional in Narayana Sewa Sansthan, and they work jointly to help needy people. Each department keeps the other departments informed, as to how the individual units are performing.
Complete development of the team members:Â Reaching final goal is the primary motive of Mr. Kailash Manav but apart from this, he also wants to bring out the best in his people. He believes in helping team members to progress in a way so that all of them can efficiently participate in the tasks and be able to contribute to the team. He organizes training sessions, and also assigns mentors to individuals when needed. Individuals get feedback on a regular basis.
Pleasant work environment: Narayana Sewa Sansthan works for the needy and the poor. Mr. Kailash Manav ensures that people enjoy their work and he encourages creativity, risk taking attitude and constant improvement.Â This also comprises freedom to fail, learn new things, and a sense of satisfaction at the workplace.Â
Inspire and motivate team members:Â Mr. Kailash Manav keeps the enthusiasm of employees high,Â inspires and energizes them by stretching goals, and takes a personal interest in their development.Â He always recognizes the accomplishments and performances of teams and employees at a personal as well as an organizational level.
Emphasize on constructive communication: Mr. Kailash Manav influences the communication exchanged within the organization in his own style. It includes goal setting, work scheduling, problem solving, corrective feedback, discussions etc. He encourages open communication among team members and communicates team opinions to and from other teams. He also provides supervision to the team based on higher management direction and discussion with other employees.Â Issues which cannot be resolved at department level are also taken care of by him. He also serves as a crucial point to connect and resolve interface and integration issues between teams.
Monitor, but do not micromanage: Mr. Kailash Manav avoids close supervision. He does not over boss or dictate. HeÂ helps the team to keep track and stay focused.
Creating Awareness: Service of the suffering mortality has many dimensions. On the one hand, it helps the victims through material items like food, clothes, treatments etc. and on the other hand, it spreads the message of humanitarian service among the masses.Â For scattering the message of humanitarian service across the World, the Sansthan regularly telecasts Sewa interpretation of Mr. Kailash Manav on many television channels in more than 167 countries.
Balanced Scorecard Evaluation
NSS has been evaluated under the Balanced Scorecard approach as follows:
Financial: There is no need to think of return on investment. The funds of the Sansthan come through donations and government grants. The return is to make handicapped and backward people independent by giving a trade to sustain livelihood.
Internal Business Process: The purpose is to give employment to as many as possible and these objectives have been consistently fulfilled. Value has been added to many lives.
Learning and Growth: There has been employee retention and the scope of activities as well as number of centers across India have increased manifold.
Customers: The polio afflicted and tribal poor have testified in their own words as to how much better they feel after going to the Sansthan. Customer satisfaction is high.
As all four criterion are satisfied and performance in accordance with overall mission strategy is great, the organization's design may be deemed effective.
While a lot of the employees of the Sansthan are the people who themselves have been helped to become independent by the NSS, not all are internally trained employees. Many of the people that have been helped out develop feelings of doing Sewa and are drawn to join the Sansthan. There doesn't seem to be involvement of any kind of internal politics in the organization as well.
As far as strategy is concerned the Sansthan takes a low cost leader approach in the Porter's strategy framework. Its base in Udaipur has given the focus of the rural sector and the primary clientele selected are the polio afflicted. While in urban areas the instances of polio are much reduced thanks to the improved efforts to the polio drop campaign it seems to have not gone down as much in the rural framework. However their low cost leadership is reflected in providing free of cost goods and services to not only the polio afflicted but to the poor, the aged, women, children and the disabled.
In evaluating the Sansthan in the Miles and Snow framework we see that it is a prospector that is constantly looking to expand the number of branches. A group of people tasked to find out both rural and urban areas where new NSS offices and hospitals can be set up are sent out frequently. This suggests a dynamic growing environment which is best suited to the prospector strategy.
Exhibit 1: Organizational Structure at Narayana Sewa SansthanAppendix
Exhibit 2: Organizational Hierarchy in USA
Mr. Anil Mehta
Dr. Subhash Paliwal
Mr. Avadhesh Agarwal
Global Vice President
Dr. Rasindhi Ji Seth
Mr. Bhagwati Lal Joshi
Mr. Bharat Toliya
Mr. Abhi Humad
Mr. Kiran Kachroo
Dr. Chiman Bhai Patel
Mr. Harish Mehta
Mr. Kishan Joshi
Mr. Dhyanoba Kenre
Mr. Mahendra Bhai Shah
Exhibit 3: Achievements of NSS
Polio Operation (Number)
Distribution of Crutches (Number)
Treatment of Patients (Number)
De-addiction of People (Individual)
Description of Medicines (Rupees)
Distribution of Sewing Machines
Distribution of Clothes (Number)
Distribution of Tri Cycles (Number)
Distribution of Foodgrain (Kg.)
Distribution of Hearing Aids (Number)
Service of Patients Meals
Distribution of Calipers (Number)
Residential School Boy's Capacity
Distribution of Vegetables on Carriage
School Bags for the School Students
Business Training (Physically challenged)
Benefitted Students in Bhagwan
Mahaveer Orphanage Hostel
Marriage of Physically Challenged (Couples)
Exhibit 4: Awards and Accolades for NSS and Shree Manav
Padma Shree award to Shree Manav for his social service by the honorable President of India
Personal category award at national level for exceptional services for the welfare of the disabled by Dr. A.P.J. Abdul Kalam
National Harmony Award by Mr. Bhishma Narain Singh
"Best Social Worker" by the honorable Governor of Rajasthan
"Best Organization" by the honorable Governor of Rajasthan