Ameera Shah, Managing Director, Metropolis Healthcare on Her Journey
A lot of people focus on the outcome of the journey from a professional sense. I will share a bit about my childhood because that is a great factor in whatever has happened for me and, of course, the journey of actually building Metropolis. It was not easy at all, and I am happy it was that way because the best life lessons come when you have ups and downs and not when it is a straight path.
My parents are Dr. Sushil Shah who was a pathologist and the founder of Metropolis and gynaecologist and obstetrician Dr. Duru Shah. I had unique parents because most Indian parents are protective about their children and want to bring them up under perfect circumstances; my parents were very contrary. From a very young age, they taught us to be independent. I travelled to Europe alone when I was 15. I was sent to lots of camps and was away for months at a time when I was much younger. They encouraged us to take risks, be independent and make our own decisions. I decided which SATs to study, I chose the professors, I entered, I applied to the colleges. I went to the US; I got my own scholarship. There was great support from my parents at the back-end but they almost never came to the front-end or made decisions for us. If I think back to the last 20 years of me building my career, a lot of those skill sets were learnt from them when I was between 5 to 20 years old.
Traditionally, especially for women in India, parents bring up their daughter very protected, wanting them to feel like princesses. Unfortunately, princesses are taken care of but princesses don’t actually take care of themselves and one thing we were always told is don’t be a princess. Take care of yourself and they gave us the tools along the way on to how to do that. The values that I learnt at home were always about excellence and never about money. We almost never talked about money at home. We used public transport, we walked to school even though there was a car and driver, we hardly went on international holidays and the whole conversation in our home was about how to make a positive impact on society, how to be excellent at what you do and there was never a conversation of buying this car or buying these things and how much money they make. When you are passionate and good at what you do, the money flows automatically. But the minute the focus is on money, the route to getting that becomes compromised. Often you see people whose focus is to not do their job well but to make money at the fastest pace. That is not what we learnt at home.
So, I was here till 17-18 and then I went to the US. I chose a public university because I could meet a lot of different people from different backgrounds. I came back to India because I was very patriotic and I feel that all of us who are in the crowd, well-educated, who have best of what India can offer, and had education over-seas, if we all leave the country then how do we give back to people? That is the reason I came back in 2001. That was the journey to then build Metropolis. I was almost 21 at that time and I saw that both my parents had built phenomenal doctor-led practices for themselves; my mother was one of the most well-reputed gynaecologists, my father was well-reputed in south Bombay and the question was, ‘is there an opportunity to make something of healthcare which is an institution beyond an individual’. As we know of medical practices in India, we all make decisions based on the doctor and the challenge and the opportunity was how do we make a brand that starts from the same values of the individual but then gets scaled across the whole country and hopefully overseas as well.
I found my father had built a very good quality practice. People respected him, they respected the quality and the services, he was doing something different and he was not just following what every pathologist was doing. So, there were a lot of unique traits to it and I thought this was an opportunity to make something much larger. That is how the journey started in 2001. It has been 20 years now; it feels very strange saying that considering I am only 42 years old but that is the reality. In the last 20 years we have gone from one lab to 130 labs and, instead of one centre, we now have 2700. We had 40 employees, now we have 4500, we were in one city, now we are in 200 cities in India and five countries. So, it has been a phenomenal journey but not one without its pricks and challenges. And even though I am the face of the business and I often end up getting all the credit, nothing is built by one person alone. It is always the team, and we are lucky to have very passionate and emotional people attached to the brand. You require that emotion to stick through and be resilient over 20 years. It doesn’t happen only through rationality. I think we have been lucky in that.
If I focus on my five key learnings in health care, especially, it is a science in healthcare first and the business second and that was a core value that I learnt from my parents at a young age. The patient comes first, your cost cutting, financials, marketing, communication, all of that is secondary. What comes first is the patient. When the patient is coming to you at a time when they are anxious, something is wrong with their body or their mother’s body, that time the whole body is anxious. So, how do we engage with a patient so that they feel we are there as partners to help, how can we lower their anxiety, how can our processes make them feel like the trust has not gone out of the window. I think that has been our focus in the last 20 years. The science is solid, the care is solid and everything else comes secondary.
There has been a lot of temptation because in every business and every industry there are players who use short-cuts. There are players who give extra discount, there will be players who market like crazy but don’t deliver, there will be players who go and do corruption. This is especially true in markets like India which don’t necessarily have minimum standards or regulatory frameworks for most things. Like in healthcare, there is no regulatory framework, anybody and anyone can start a path lab. So, you try to do the right thing, you try to have good governance, you pay your taxes while other labs don’t; either that or they don’t do the tests properly. Holding on to core values and purpose of the organisation has been one of the most important learnings; to never be side-tracked with what other people are doing, no matter how tempting it may look in the short-term.
The second is to be fair and transparent to our employees, customers, investors and stake-holders, at every stage, building your reputation which is going to be your biggest asset and that is the most important thing that you are going to do. I have heard a lot of Indian promoters say, ‘The investors are just riding off my coattails and they don’t deserve to make so much money. So, why don’t I cut them off and buy them off cheap and I will make more money.’ But when you do that, and an agreement is breached, even the letter, spirit of the agreement is breached; that will come back to you and be a problem to you. Being fair and transparent is critical in building the brand as an asset and your own reputation too. In 2006, we had four investors, the next time in 2010 I had almost 10 investors who were interested. Then, when I came in 2015, when I was looking to buy out hostile partner stakes and get them out of business, I decided to buy Warburg Pincus’ stakes. It was easy for me as a promoter to haggle with them and negotiate and get them out cheap but we chose to pay them a fair market value as what was determined by third parties and I did that by actually taking debt from KKR and then buying out Warburg. Now that debt was, by the way, at 20% a year, excruciating debt and interest rates but the reason we did that was because we believed in the business and secondly, we did not want to cheat anybody of their deserved value. So, investors have been happy to back us because they hear about our fairness in the market. I am a big proponent of integrity being a critical part of the way you build a business.
The third lesson my father taught me when I was very young when I was 7-8 years old, and he would ask me what I wanted to be and what I wanted to do. I had a new answer each time: interior designer, fashion designer, astronaut, architect, lawyer, etc. He always said, ‘I don’t care what you do, you want to be a hair-dresser, clean garbage, whatever. But you be the best at what you do.’ ‘Be different’ was something that was told to us from a very young age. That was not only in terms of profession but also in terms of thought and behaviour. Be comfortable in being different, especially in India, where we are conditioned to follow a similar thought process. We are afraid of what society will say about us or our families if our children or we do something weird or strange, a little bit out of the ordinary. But often, it is the one who thinks differently who actually lands up finding a different path and a different journey. Not feeling the pressure of being the same, that is actually something my father gave us very early. We were always told not to worry about what people said about us, do what we believed was right and as long as we were comfortable with it, they backed us fully.
In our journey in Metropolis, we have been pioneers, we have done things differently. We are the first in starting new tests, whether in saying we are going to approach things differently, or whether in saying that in our industry there tends to be corruption and we are not going to be a part of that because we are going to do things the straight way, the honest way. That has really paid off for us, the comfort to be different.
Fourth, we not only have to have the right to win but we have to deserve to win. I have seen businesses where a crazy amount of money is spent in marketing. Start-ups are the best example. The amount of money spent in acquiring a consumer is amazing but the amount of energy put to retain the customer and to keep your consumer happy and engaged is not always as much. Our focus has always been that we have to deserve to win, whether in new markets like Africa, whether a new service line, or the way of doing things. We have to be so good that we not only have the right to win but we deserve to win. Building substance over the style has been a critical and fundamental part of how we built Metropolis.
So many people ask why we don’t make our centres flashy and large, beautiful-looking? We always say that if we have a certain amount of money to spend on profit and loss statement, it is a choice whether to spend that money on amazing-looking five-star centres or do we spend that money on our back-end to make sure our quality is right every single time and still have reasonably good-looking centres. Should we spend on quality and standards, and service and the answer, every time, is that substance should be more than the style because in healthcare what matters is the assurance and trust and credibility of the report not whether you were given a cup of orange juice with an umbrella. I think that has been a big focus in leading and building a credible brand throughout.
Last is more about the leader than the business. When you are the leader of a start-up, your start-up is a mirror image of you. If you are anxious as a person, the culture of your start-up will be anxious, if you are impatient, the culture will start the same because you are the start-up. When you become mid-sized organisation, you allow other people to influence your organisation. When you are large, the leader’s job becomes more about how do I stay the soul of the organisation because there are so many influencers, how do I keep to the values of the organisation. One of the most important things that a leader has to do as an entrepreneur maintain self-balance because otherwise, our emotions land up being super-imposed on the organisation. So, one of the things I have tried to do is to use every step in my journey, whether it is joining here with you all at Rotary and build new relationships, YPO where you get inputs and you get other people who tell you how to do things differently and their own experiences, whether it is about hobbies or work or parenting, each of these are times in our lives which we come to know a little more about ourselves and how we can use that influence to balance ourselves and our emotions because as we balance them it has a better impact on ourselves. We land up making better quality decisions when we ourselves are more balanced and that is the other learning in terms of how much energy and effort is to be put in managing myself. So, I can therefore make better decisions for my organisation.
These have been some of the learnings and the journey has been very long and I can talk a lot more but one of the key messages that I am always left with is that any sort of power that all of us have in our family and businesses is not so much about being powerful, it is really about being powerful and empowering others and how we can use the power that we have received as heads of families and businesses to empower others in their journey. I think it has been for me one of the biggest and more fulfilling understandings and as I have gone through implementing that and mentoring others by helping others in their journey, that has been an extremely fulfilling part for me. I know clubs like Rotary and others are actually part of that, in how you impact lives of others. For me, my platform for empowering which has been about helping other entrepreneurs, especially women entrepreneurs because it is a very lonely journey. There are not many women entrepreneurs in the country and unfortunately there are very few role models and the journey is very different to the male entrepreneur because gender-bias does come in. Challenges do come in and a lot of them are internal. So, providing that support, that learning to go ahead and dream big, actually go and achieve the dream, it has been a great journey for me in doing that.
Last one and a half year again has been very interesting. In March last year, I gave birth to my first child, literally 10 days before lockdown and then we went into lockdown and I was estimating that I would have 45 days of break where I could just focus on my child. That was not to be and Covid hit and we got into 8-10 hours of policy making with the government every day from homes and then came building Covid labs, operations, scale it up and provide it to all people who needed it and of course we had to continue running our rest of the business as well. But what was really an interesting learning for me in the past 18 months was when March happened and everybody’s revenue and profits tanked, because nobody was coming out and utilising services, health care was also badly hit, we had a drop of 70-80% in revenue and there was the temptation again to take short-term actions to say slash, cut and burn because how do you survive? How do you pay salaries and provide services? One of the learnings we had was that our employees at this stage are actually more important than the customers because our employees were risking their personal safety every day, leaving their own families, going to offices, being beaten by police on the ground at instances and we had to make sure that our employees were fully taken care of, mentally, physically. They were reassured that the organisation is behind them because you can imagine the situation. We were getting 4000 calls a day and over night it jumped to 12000 calls a day. So, how do you deal with that? You can’t do anything overnight.
Overnight you are bound to be in a situation where your customers are unhappy. Now when the customer’s unhappiness comes, it comes all on the team. On one hand they are scared of their own safety, they are not vaccinated, they are scared every time they go to a patient’s house, they have management putting pressure on them so, these guys are getting sandwiched and completely burned out. So, we decided our focus would be on their safety and well-being and we did everything possible to support them. We did not look at cost. We threw a lot of money and communication at the problem and the benefit of it was, we have seen lowest attrition that we have ever seen in last years because people felt backed. We have seen the way we treat our employees is the same way as the way they treat our customers especially in services business where empathy is such a critical path of what you try to communicate and we end up having a team that is more committed and emotional than ever before.
So, our decision on not cutting salaries, not doing any of the short-term actions and only focussing on long-term steps and employees helped us survive as well as thrive in this Covid crisis and hopefully along the way we have helped millions of people as well. That has been a little bit of the journey.
How did you transfer the culture across all the centres? Do you have a process?
Culture building is the hardest part of the journey. The culture comes from some tactical things and some strategic things. The tactical things include communication, training, communicating passion. Often, I tell all my guys that we receive thousands of samples a day, it is easy to look at it as a factory. But for the person giving the sample, it is their only sample, it is their parent’s sample, brother’s sample, own sample and for them that sample is everything, it is days of stress and anxiety. How can each one of us treat every sample as our mother’s sample, and if we can do that, that differentiates us from everybody because that level of empathy is very difficult to transfer across thousands of employees. A lot of it comes from us being obsessed with patients. Till date, if I get an email from a customer who is upset, we dig down to the detail, we go down to the root, it is not just me but also my team, we all go down to the root, how did it happen, why did it happen, how can we comfort the customer and how can we solve the problem. So, a lot of it is about leadership action, of course a lot is about the processes and systems and the kind of team that you have, the recruitment itself, it is a combination of all. And it is never a one-time project. It is an on-going project every day because in India, the attrition levels are so high in every industry. Everyday, all you are doing is training and training.
Have you thought about home-diagnostics? That has taken off in the US right now.
Home diagnostics have existed for years, it is not new. Even the glucometer that you use is home diagnostics, right? But if you compare results between a glucometer and a lab like ours, it is only 70-80% accurate because home diagnostics take blood from the capillary which is a finger prick and is not stable blood because it is mixed with air, it gives you variable results. So, they are not consistent, science has not yet got to the place where home diagnostics are as reliable as what you see in lab like ours. So, I think it will come but science needs to move a little further.
Your comments on the case of Elizabeth Holmes and using private equity and valuations.
Elizabeth Holmes and Theranos is a story about a young woman who was a scientist, researcher and found technology that could do tests quickly and do multiple tests by one prick of blood and it went on becoming a huge phenomenon where the company was valued at 9 billion even though they had no revenue, they had powerful men on the board, etc., She was on the cover of every magazine. I remember this happening and so many well-wishers would send me links and articles saying why are you not doing this and I used to tell them it is very new, let’s wait and watch what happens because healthcare is one of those industries where you have to focus on substance over style and I know that from the inside. The way and the angle in which we collect your blood matters. Because if we land up getting a clot, the result will be 100% wrong, the number of times you shake the tube matters because the clot either gets dissolved or not, the container in which we collect the blood has chemicals at the bottom. Now a large number of labs will take shortcuts as to why do we need these chemicals and just collect in plain tube. But if you don’t get the chemicals, you don’t get the right results. In our country today, there is no regulation at all for what you have to do. Nobody is watching. When you go to a path lab, it depends on them and their conduct about whether they take care of the quality or whether they take short-cuts. That is where we were clear that we will never take shortcuts however tempting it may be. We have American agencies come and audit us every year and check us every month because we want to stand for that. Holmes did not do that, they did not have a clear value-system on how they will operate. Private equity is a good thing, but you have to be clear about your goals and boundaries. Often, I have seen businesses who are in hurry. It is not just 20 years of my journey; it was 30 years before that of my father’s journey. So, businesses in a hurry have to compromise on something. To me it is a case of a lack of moral code and boundary and getting caught up in the momentum of outcome of the business rather than input.
Have you seen any pattern in terms of Covid? Are we nearing end?
If we go to March last year, we went to our farm house, and we were sure that this is not going to be short term. Viruses are just like this, even if you go back of last year December, N44 K got wiped out by B1617 because it is survival of the fittest. The new virus kills other viruses and becomes alpha of viruses. Now the vaccines that have come in can only protect us against the mutations that we already know of. If the virus mutates, it will affect us and spread. The vaccination protects us from severity. We have to keep updating our antibody and vaccine status, at the same time the virus will mutate itself. So, there is no guarantee that we are not going to have a third wave and there is no assurance that we are at the end. It depends on the pace of vaccination and the pace of mutation. I think in India we are at a slight disadvantage. But if we look at this city wise, it can be handled well. Mumbai is still at risk. There is an increase, I will recommend vaccination.
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