IHS Case Study

Integrated Health Services

DR. ASIM MAHMOOD-THE PROFILE OF A PATHFINDER

“Dr. Asim is a very creative individual. He will never follow the conventional path rather he will try the hardest thing which comes his way and also he is very quality conscious. He never projects his name rather he always talks about Integrated Health Services. He loves to make systems and whenever people ask him for using his systems he never says “no”, he says come and learn. He is never ever a miser. Asim believes in teams and it is the motivation of Asim which is reflected everywhere. To work with Asim you should know him”.

Dr. Ali Raza (Member Top Team)

After proving his success in his native country, Dr. Asim Mahmood, an entrepreneurial leader was thinking of expanding his business overseas. He was particularly looking at United Arab Emirates and his friends were ready to entertain him for the “Look-See” visit there. The purpose of the trip would be looking for opportunities in the area of providing school health services in UAE.

Integrated Health Services (IHS) - Pakistan was not established as a commercial venture rather the intent was to provide quality health services in the neglected areas. The business of Dr. Asim Mahmood had considerably spread and the portfolio included seven different units namely Health Consultancy and Infrastructure Development, Occupational Health and Training, School Health, Home Medical Care, Emergency and Rescue Services, Clinical Care, Lab and Vaccination and Corporate Health.

Dr. Asim Mahmood- being the Executive Director of Integrated Health Services was a pioneer in providing school health services in Pakistan. He and his wife cum business partner Mrs. Asim are the owners of this business and were now leading an increasingly viable service across the different cities of the country especially in the Islamabad-Rawalpindi region. Refer to Exhibit 1 for complete business operations of Integrated Health Services.

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Assistant Professor Ch. Fazle Muqeem and Tehreem Waheed (MBA Final Year Student) FAST Business School, Islamabad, Pakistan prepared the case solely as the basis of class discussion. Cases are not to serve as endorsements, sources of primary data or illustrations of effective or


HISTORYDr. Asim Mahmood, an M.B.B.S, who graduated in 1992 from Rawalpindi Medical College, Rawalpindi, had no issue in going abroad for higher studies after graduation, but he decided not to go abroad and serve in the area of primary health care. He thought of serving in this area because he was of the view that primary health care is a neglected area and needs to be attended to. Dr. Asim never looked at a straight career for himself instead he was looking for innovation, excitement and unique projects. He did his MCPS in Family Medicine and MRSH from United Kingdom and MIOH from Finland.

ESTABLISHMENT OF AIRPORT MEDICAL CENTREAfter graduation, he did his MCPS in family medicine in year 1994 and started off with a small clinic named Airport Medical Centre in Rawalpindi. For establishing this small clinic he took a loan of PKR 10, 000 from his parents. Dr. Asim recalled that he earned PKR 80 on his very first day and after two months he earned PKR 53,000 which was a reasonably good amount at that time. People started trusting him and his revenues increased. Concurrently he was also looking for government jobs because there was family pressure to have a stable stream of income alongside the business. This was obviously the family point of view but Asim believed that normally there are two types of working people, one who are employees and the other who are employers and he definitely wanted to be the part of the later group.

ASSOCIATION WITH GOVERNMENT In March 1996, he got three offers from the government and he joined a government health institute in G-8 Sector, Islamabad. Also he used to sit at his clinic in the evening from 5 p.m. through midnight. He was never happy with his government assignment, because he was doing Pathology which was not his specialty. While there were never many adventures to seek with the morning job, his evening clinic was really picking up and he had reached a threshold of 150 patients a day. On the day he received 150 patients at his evening clinic, he decided that he could not stretch himself more and so in order to give more time to the clinic he resigned the government job the next day. His decision and subsequent resignation made the family a little unhappy.

THE PAKISTANI FAMILY MODEL-IN AID OF ASIMWhile Asim was defining the new career path he had already married and the first child was born. Mrs. Asim recalled that:-

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“This was a critical time when he left the job, but our basic necessities were being fulfilled because we were living with the parents of Dr. Asim”.

She (Mrs. Asim) further commented that both set of parents understood the burning ambition of Dr. Asim to go it alone and were supportive of his new career in the long run. With the family right behind him Dr. Asim added a laboratory and a vaccination centre in his clinic and hired another person for help. Whatever he earned he invested back into his business. He was earning handsome revenues from his clinic and the Airport Medical Centre was growing with Dr. Asim being totally hands-off in terms of the management of the facility. Being a restless soul he was now looking at the area of home medical services as being the next area to target.

THE BIRTH OF IHSIn order to fulfill the purpose he established “IHS: Integrated Health Services”. He named the company “Integrated Health Services” because he practically integrated all the possible home patient care issues under one canopy. Dr. Asim remarked:-

“My dream was never to buy flashy cars and property; rather I wanted to do something for the society”.

Asim firmly believed that Pakistan and Pakistanis had to look beyond the over arching hand of the government to achieve prosperity hence, he felt assured that the response in this area would be overwhelming. The idea also sat well with his notion of being self employed and his oft quoted and repeated observation:-

“I would much rather be a cobbler and be self employed rather than being a well paid employee”.

THE START-UP BACKGROUND-IHSWith his dreams on the platter in mid 1997, Dr. Asim Mahmood successfully established IHS with a focus on, home medical services, laboratory services (at the door step of clients) and school health services. The first two were his own ideas, and the third was presented by a mentor, who was a school health advisor at a multilateral agency. This mentor upon leaving his job with the multilateral agency, asked Dr. Asim to introduce the concept of school health services in Pakistan because it was a neglected area.To jump start home services, 1000 flyers were printed, and were thrown in at random in the residential area of Sectors F-8 and F-7 of the Capital City. A reflection of the flyer is appended at Exhibit-2 to the case. Dr. Asim received the magic call (so to say) on the third day after distribution of flyers. The caller requested vaccination of Hepatitis B at a house located in Sector F-8 of Islamabad.

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Fortunately, there were two patients and both were prominent political leaders of the country. Dr. Asim’s business broke even the very same day and the cost of the flyers was recovered. With the passage of time the revenues stream started building up and the word spread that home care services are available at the door step. The intensity of calls increased day by day. They were receiving calls for checking blood pressure, blood sugar and vaccination etc. It was at this point that Dr. Asim hired a paramedic Mr. Saeed Hashmi who was the first employee of IHS and continues to serve to this day reflecting upon the kind of commitment Dr. Asim evokes in his employees. Before joining IHS Mr. Hashmi had served the Pakistan Air Force for 18 years in their nursing department. Dr. Asim chose Mr. Saeed Hashmi as a final candidate for his health centre from a long list of candidates.

Mr. Saeed recalled that:-

“Previously I was serving Pakistan Air force and working there was a straight forward thing. When Dr. Asim told me about his future aims I joined Integrated Health Services considering this to be an exciting opportunity”.

Refer to Exhibit 3 for the video recorded interview of Mr. Saeed Hashmi.

Alongside the effort to deepen the home care services Dr. Asim starting touring different schools for introducing the idea of school health services. As it was a new idea in Pakistan so it was a hard challenge to persuade these institutions to join up. However, Dr. Asim used his perseverance to the maximum. Mrs. Asim elaborated that:-

“Dr. Asim is very optimistic by nature; he never creates fuss or makes issue of any problem/hurdle which comes in the way rather he thinks that every problem is God given and He will provide the solution also”.

A PRODUCT OF FAITH & FAMILY SUPPORTDr. Asim had a strong faith in Almighty Allah, he observed:-

“Whatever happens, either good or bad, it happens due to the will of God”.

Mrs. Asim- being the mother of two kids is also a doctor by profession and she explained that being in the same profession was an added advantage for both of them as they shared similar interests. After the birth of the first child she took a break and later joined the husband’s business. Mrs. Asim wanted to pursue surgery but later looking at the

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emerging family commitments she first went to Radiology and then to Public Health. She was very happy now as the family had always been her primary focus. While commenting upon the critical times which she faced as being Dr. Asim’s spouse, she explained that at the start Dr. Asim received three job offers from the government but his heart was set on initiating his own work hence he convinced the family to let him go his way. His wife remembered that at that time (and even now) whenever he talks he is very convincing and so he tends to have his way. She observed that although there were many ups and downs, Asim’s confidence and grit carries everyone through. She also remarked that:

“Asim is very good at hiding things” And

“Asim doesn’t portray the problems as such rather he always thinks of new things”.

Mrs. Asim stated that her Parents-in-law are very supportive and they helped them in every way. Rather the father of Dr. Asim is always there with good advice and the mother is always praying for Asim’s success. Mrs. Asim explained that:-

“I am very much privileged that we are living together (i.e. with the parents of Dr. Asim)”.

Mr. Saeed Hashmi commented that:-

“Mr. Bashir – the father of Dr. Asim has a very supporting role for the whole staff of IHS and he is a very good person”.

BULDING IHS & THE UPHILL STRUGGLEBeyond the family support Dr. Asim continued to build IHS and never felt disappointed. Dr. Shahid, an early joiner like Saeed Hashmi and a member of the core team recalled about Dr. Asim:-

“He (Dr. Asim) is very consistent in nature and he never let go of hope even though there was little success in the start”

In this back drop Dr. Asim continued visiting schools and presented his idea during the year 1997 but unfortunately he didn’t get any client. However, as a typical pathfinder his struggle went on and thus observed Dr. Shahid:-

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“Dr. Asim used to work continuously for even 18-20 hours for establishing IHS and for making the systems work”.

The idea of school health services finally got Asim into business and one private school agreed to open an IHS clinic on its premises. IHS was paid annual charges of PKR 250,000 which were provided in advance by the school. A similar agreement was also signed between IHS and another school in Rawalpindi at the same time. Refer to Exhibits 4(a) through (c) for evidence in this regard.

ASIM AND THE WORK-FAMILY BALANCEMrs. Asim- as a mother of two kids remarked that “we miss out on Socialization, I go on my own, unlike other couples” and further elaborated that:-

“Everybody has to do some sort of adjustments in his/her married life”.

But, she had no regrets and commented that “Asim never made a wrong a decision”. She remarked that:-

“My career is a compromised one and I have no regrets and I don’t want to put my kids at stake”. She further elaborated that” one has to set his/her role and priorities and then work accordingly”.

Dr. Asim has a unique sense of keeping the work-family life balance and despite his busy schedules he is the storyteller who puts his young kids to sleep at night. Although her wife described that:-

“At times he doesn’t even remember the academic classes of the kids…but believes that his daughters will run the Business when they grow up”. Please see Mrs. Asim’s video interview appended as Exhibit 5 to the case.

DR. ASIM-THE ORGANIZATION BUILDERMrs. Asim commented that “Dr. Asim has been a source of inspiration for his friends” and also his way of thinking is “conviction and hard work is required for whatever you are doing”. She recalled that:-

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“Partnerships never suited us, we were always deceived”.

The Work Environment at IHSThe Director Projects remarked:-

“It is the team work and family friendly environment within Integrated Health Services which is a reason behind its success”.

The Manager Home Medical Care mentioned that:-

“It’s a family friendly environment here at Integrated Health Services”.

There is no issue of timings as long as you complete your work and satisfy the clients. Also Dr. Asim is great believer in trust. This is one reason why people do not leave his set up.

Human Capital Begets Financial CapitalAs Doctor Asim worked on both the Home Care and School Health portfolios the work force grew to eight employees. Mr. Saeed recalled that:-

“Dr. Asim gave me free hand and encouraged me to hire individually other male and female nurses. He trusted me to that extent that he made me accountant also. Now, I am working as Manager Home Nursing Care”.

The Director Projects believed that:-

“The IHS staff gives outputs because they are emotionally involved in their work”

The Manager home medical care being a very senior employee at Integrated health Services remarked that:-

“He gives us (the IHS staff) handsome salaries plus a yearly increment. Also if anybody among the staff needs immediate financial help he provides us that, without any delay”.

Dr. Asim was now at a stage where he wanted to take his organization into newer segments and hence the penetration into the Home Nursing Care Services.

START OF HOME NURSING SERVICES

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As the first penetration into this service area, Dr. Asim and his team were able to successfully provide ICU- services for thirteen days, at home in a room for a female patient residing in Islamabad, who was suffering from Hepatitis-C. The lady suffering from the disease was the wife of a building contractor in Islamabad. The person took his wife to London for medical help and she remained there for sometime but didn’t get well. So the husband brought her back, as it was the desire of the couple. It was in this context that Dr. Asim was requested to set up the ICU. Dr. Shahid recalled that:-

“When we provided ICU services at the door step of a patient we provided medical instruments from thermometer to ECG machine on our own”.

Dr. Asim hired doctors and trained ICU nurses. At that time school health and home care businesses were going pretty well, and so Dr. Asim took IHS into the corporate sector.

ENTERING CORPORATE SECTOR: 1998-1999By the end of year 1998 and start of 1999, Dr. Asim made proposals for different organizations like leading multinationals in oil industry and tobacco industry for providing vaccination services.

HEALTH SERVICES TO THE LARGEST PRIVATE SCHOOL NATIONWIDEIn year 1999, Dr. Asim got a chance of making remarkable penetration in the area of school health services. One day he got a call from the head of the largest private schools system of the country. He was asked to come to Lahore and present his ideas on school health to the Executive Board of the school. Dr. Asim went to Lahore made a persuasive appeal and got the contract to provide vaccination services to all students in all branches of this school. The target was achieved and 52,000 students were provided with vaccination services. Refer to Exhibit-6 for the service contract and to Exhibit-7 for Dr. Asim’s views on this contract and many of his other targets that he has been able to deliver on. By now IHS was firmly established in home health care, vaccination services and corporate health..

END YEAR 1999 & START 2000-MAKING HEADWAY INTO CORPORATE PAKISTANAt the end of 1999, Dr. Asim and his team made contact with the Islamabad Traffic Police for vaccination of Hepatitis-B. For that purpose Dr. Asim had a meeting with the Superintendant Islamabad Police and successfully sold him the idea. This opportunity created worth and credibility for Dr. Asim and his company. Allied to this opportunity was the inauguration of Rescue 15 in Islamabad. As the name suggests

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they offer relief and help in emergency, accidents, thefts and other disasters. Dr. Asim was hindered to operate because he did not have ambulances so he convinced The Red Crescent Society to volunteer two ambulances to Rescue 15 where IHS team was providing free of cost services. Refer to Exhibit-8 for the service agreement. The flood gates now opened IHS was able to provide emergency medical coverage to the development arm of a Multilateral Agency. A multinational petroleum company requested Dr. Asim and his team to provide a field hospital in Sind and Dr. Asim Obliged. In 2002, due to time constraints, Dr. Asim sold the Airport Medical Center. Also in May 2002, IHS managed a big break of penning down a company health care agreement with one of the largest conglomerates of Pakistan.

JOINED DISTANT LEARNING PROGRAMOne of the outstanding accomplishments of Dr. Asim has been that along with his company he has also developed himself. He has never lost an opportunity to upgrade his skill set. He therefore applied for a distant learning program in occupational health and got membership from the Finnish Institute of Occupational Health, Finland. Dr. Asim has the distinct honor of being the third Pakistani to have been awarded this certification. With this new degree in his hands he further expanded his business and started Research and Health consultancies, which has become one of the highest revenue earning areas. During this time Dr. Asim also consulted to provide National Guidelines for the Prime Minister’s nationwide Health initiative.

IN SERVICE OF THE NATION- BALAKOT & SAVE THE CHILDRENDr. Asim and IHS have always conducted business through morality and nation building has been one of the major themes of his work, hence the involvement with the earthquake stricken areas and the work with NGO SAVE THE CHILDREN. For the city of Balakot the UAE Red Crescent Clinic was established in the year 2006. The staff of this clinic comprises 17 employees including two lady doctors, two male doctors, security guards, dispensers, computer operator and sanitary workers. Dr. Asim from IHS Islamabad is administering this clinic and monthly record is sent to IHS, Islamabad. The doctors here are in touch with Dr. Asim and whenever they need any help and guidance, Dr. Asim is there to provide it. Mainly the patients who come here for treatment are suffering from skin diseases and seasonal problems. The patients from Kaghan, Naran, Mansehra and Ghari Habibullah also come here for the treatment. IHS-Red Crescent Clinic Balakot has had the honor of serving 1,40,000 patients, free of charge to date. The health ministry of United Arab Emirates is providing funding for this clinic on a six monthly basis. Refer to Exhibit 9 (a & b) reflect upon the agreements done with UAE Red Crescent and SAVE THE CHILDREN.

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IHS- THE COMPANY OF ETHICAL PRACTICESThe company seems to have separated from the owner/creator and has developed an identity of its own, Dr. Shahid Nadeem had an interesting remark to offer in this context:-

“No other organization is working like Integrated Health Services with ethical practices and standard operating procedures. Currently, I am working as Director Projects. When IHS was established, there was no competition at all. Unique services at the door step of clients were being provided at that time from the platform of IHS. We use to take very low profits for superb services which we provided, because at IHS we can’t compromise on quality”.

Dr. Shahid added:-

“Our motto is client satisfaction first no matter if while doing so substantial revenues have to be sacrificed.”

Dr. Ali Raza acknowledged that:-

“IHS believes in making systems and efforts should be done to meet standards”.

DECEMBER 2002: DR. ASIM & CORPORATE TRAININGS:

In December 2002, the business volume of IHS was getting low, so in May 2002 Dr. Asim took a strategic decision to join regular employment once again in a leading company in the oil sector. Also he thought to start providing trainings of first aid at corporate and school level and consulted Pakistan Red Crescent Society for that matter. Dr. Asim and his dedicated team launched a program known as “FATS” abbreviated for First Aid Training for Schools. The duration of the training was six hours. Dr. Asim, himself was the master trainer and he trained his staff, so that they will be able to provide trainings at different schools. And so Dr. Asim tried to dilute the cyclical effect of the business. A contract was duly signed between IHS and Pakistan Red Crescent Society, who were the sponsoring agency. Refer to Exhibit 10 (a & b) to reflect upon the market niche that Dr. Asim made in this area. In the original contract it was decided that Rs. 2000 per training will be given to Pakistan Red Crescent Society. But, after two to three months the head of Pakistan Red Crescent Society ended the contract. Later on, the first aid trainings were provided solely by IHS. As the profit

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margins were low in schools and colleges, so Dr. Asim turned to the corporate sector where he already had a presence. The first break on this leveraged path came from a multilateral agency and IHS charged Rs. 25,000 for the event. The next break came in the tobacco sector with a leading multinational. The first aid trainings for this tobacco company were provided at its different factories in different cities. This was a major hit for IHS and the top management at this leading tobacco company was very much impressed with the work of Dr. Asim and his team. On a query by the top management of the company Dr. Asim decided to go into trainings in occupational health, general health and ergonomics. The contract that Dr. Asim won was worth a couple of million rupees and it was decided that trainings in general occupational health (for factories workers and office staff), ergonomics trainings (for office staff only) and first aid trainings for both will be provided in one year. Dr. Asim and his team not only provided the trainings but won the confidence of the company and to date the organization is a client of IHS. In terms of capacity building of the organization Dr. Asim has converted IHS into a total solution provider for the healthcare needs of his corporate clients. The services include:

Managed health care ( IHS was pioneer in introducing this concept)

Training services Creating health awareness Arrangement of hospitals on panel for employees Claims verification of medical bills Rescue and emergency care for employees based in Rawalpindi

and Islamabad Providing health policies Acting as health contractors ( IHS was pioneer in this field, and

was providing health contracting services to oil companies)While acting as health contractors, IHS has also had opportunity to send doctors to the oil fields in Oman also.

Institutionalizing Training CapabilitiesMany other companies also contacted IHS for trainings in stress management and other topical areas and Dr. Asim obliged this time by bringing in trainers and paying them a share of the profits. According to Dr. Asim, running an organization is not a “one man job”. He believed that good, loyal, honest and sincere people are required for doing a good job. Therefore the complete devolution of authority to Dr. Ali Raza and Dr. Shahid Nadeem for running the children hospital and the Medical Center in Sector I-8. He is now operating at the strategic level. Dr. Asim’s Mantra is:

“I might lose money but I would not lose systems”.

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DEVELOPING EMPLOYEES- EXAMPLE DR.ALI RAZA Dr. Asim newest venture is the Children Hospital in the, F-10 Sector of Islamabad. The hospital broke even after three months. Dr. Ali Raza being the Director of Integrated Health Services Children hospital F-10 Islamabad observed that the idea of this unit stemmed from a real need. Catering for the health needs of children government hospitals are there but there are a limited number of beds for them and quality health services are also not provided to them. In this context the F-10 facility was established. The facility is now a year old. The environment of the hospital has been created keeping in view the comfort needs of the children. Refer to Exhibit 11 for the video interview of Dr. Ali Raza. Free of cost health services are provided to the poor and the needy children at this hospital and a charity profile is kept for this category of patients. A feedback system is maintained in the hospital and according to this feedback system the satisfaction level of the clients is near 100%. Parents are very much satisfied with the services which are provided here. Also the response time is very quick here. Doctors and other medical staff give patients enough time and enough care so when the parents leave the hospital they are satisfied. Follow-up calls are made; a day after the child is discharged from the hospital just to inquire about his/her health. Because of these practices patient referral has become an important source of bringing in more business.

CLIENTELE IMPACTThe Director Projects at IHS remarked that:-

“Dr. Asim doesn’t have a bossy attitude at all, rather his emphasis is on services provided to the clients”.

The mother of Ms. Salma Khan is a client of Integrated Health Services for the last ten years. Ms. Salma commented that:-

“My mother is old and ill as she can’t walk and communicate so I am availing the home care services from IHS since the earliest times and I am a very satisfied client. They provide twenty four hours medical services and when you call them its like a hospital coming into your home. They know me and my mother very well and I know them very well. I have confidence in them as I have crossed many bridges with IHS because of my mother’s illness”.

The lady was so much impressed and satisfied from their home care services that she is writing a book named as “Hands on the

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shoulder” on her experiences with her ill mother and the services which should be provided to such a category of patients.

Dr. Tariq is working as a health advisor for a large multinational company in Islamabad. As a health advisor they are availing the services of Integrated Health Services for their company. Dr. Tariq is responsible for the clinical and personal health of all employees at this company. He observed that there were a number of reasons for which they chose IHS. Some of the more important reasons were:

IHS has better infrastructure Requisite experience of working with other

multinationals Worked in the area of school health care Worked voluntarily during earth quake IHS – are pioneers in their work Are trust worthy and have a very good team

Another reason cited by Dr. Tariq was that they continue to build special expertise in certain areas like:-

“Very few people are there, who have worked in the area of ergonomics and Integrated Health Services is among one of them”.

RELATIONSHIP OF THE CLOCK AND THE CLOCKMAKERThen the critical area now is to see as to where Dr. Asim stands in terms of his impact on IHS. Dr. Tariq (the health advisor of the large multinational being a client of IHS) had the view that:-

“I know Dr. Asim for a long time, he is a very good physician, and I found him committed to whatever he is doing. He has a vision and he is working rightly for the achievement of that vision. Also he tries to create a better environment for the people of his company. Asim is a kind of person who works very hard and in his case I must say “Persistence always pays” ”.

A very satisfied client observed:-

“I respect his diagnostic and clinical ability. As a doctor he is brilliant. There are a lot of good people working in this country who are working for the betterment of the society. I think it’s a wasted life if you don’t help others in the hour of need”.

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Director Projects stated that:-

“Dr. Asim has stuck to the same business from day one with the same zeal and motivation. He never left IHS, although he got many offers to go abroad”.

Director IHS Children Hospital believed that:-

“Asim had a novel way of doing things. He brings into reality his imagination”.

Manager Balakot Medical Facility observed:

“Dr. Asim is a very good and benevolent administrator”

While the training business seems to have taken a hit the school health business is doing very well. Currently IHS is working as the market leader in school health area.

“Now after almost 10 years in school health, IHS is a market leader in provision of various types of health services to the educational institutions in Pakistan. Due to the commitment and non-commercial approach IHS is the largest operator of school health in the country with over 0.8 million students enrolled so far“.

In a way the life time contribution of Dr. Asim to the health sector is his own words is that, “there is a consumer everywhere” all you need, is to harness the energy of your organization in the right direction and with a sense of purpose.

WHERE TO GO?From the continued life and work of successful leaders like Dr. Asim there are many lessons to be learnt and the key is to remain persistent and to fear nothing. It may also be useful to remember that in Pakistan, Dr. Asim has been a pioneer in providing health services but he is now going to try his luck in United Arab Emirates. It is a different market, The critical factors which should be kept in mind before going there could be that, Are there people present in UAE who are already providing this kind of service? Will they welcome the school health services provided by Dr.

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Asim and his team? Will his leadership and management philosophy developed for Pakistan work in a different environment? Is he not becoming too commercial and overambitious?

BUSINESS OPERATIONS

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Figure 1: Showing business operations at Integrated Health Services

Source: Company Documents

TEHREEM’S VERSIONINTEGRATED HEALTH SERVICES

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“Dr. Asim is a very creative individual. He will never follow the conventional path rather he will try the hardest thing which comes in his way and also he is very quality conscious. He never projects his name rather he always talks about Integrated Health Services. He loves to make systems and whenever people ask him for using his systems he never says “no”, he says come and learn. He is never ever a miser. Asim believes in teams and it is the motivation of Asim which is reflected everywhere. To work with Asim you should know him”.

Commented by Dr. Ali Raza

After proving his success in his native country, Dr. Asim Mahmood, an entrepreneurial leader was thinking to expand the horizons of his business. For that purpose he contacted his friends in United Arab Emirates who will take the charge of his accommodation during his one week stay in United Arab Emirates. The purpose of the trip was to make a ground for providing school health services in UAE.

Integrated Health Services- Pakistan was not made as a commercial organization rather the purpose was to provide quality health services in the neglected areas. The business of Dr. Asim Mahmood was spread into seven different units namely Health Consultancy and Infrastructure Development, Occupational Health and Training, School Health, Home Medical Care, Emergency and Rescue Services, Clinical Care, Lab and Vaccination and Corporate Health.

Dr. Asim Mahmood- being the Executive Director of Integrated Health Services was a pioneer in providing school health services in Pakistan. He and his wife cum business partner Mrs. Asim are the owners of this health business and were earning handsome amount of revenues from their business. Refer to Exhibit 1 for complete business operations of Integrated Health Services.

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This case was written by Tehreem Waheed as her final year project under the supervision of Sir Fazl-e-Muqeem, as the basis for class discussion rather than to illustrate either effective or in effective handling of an administrative situation.


HISTORYDr. Asim Mahmood, an M.B.B.S, who graduated in 1992 from Rawalpindi Medical College, Rawalpindi, has no issue in going abroad for higher studies after graduation, but he decided not to go abroad and serve in the area of primary health care. He thought of serving in this area because he thought that this is the most neglected area and took a firm decision to do something on his own in this field. Dr. Asim is not like an ordinary doctor; his career is full of innovative and unique projects in which he had remarkable success.He did his MCPS in Family Medicine and MRSH from United Kingdom and MIOH from Finland.

ESTABLISHMENT OF AIRPORT MEDICAL CENTREAfter graduation, he did his MCPS in family medicine in year 1994 and started off with a small clinic named as Airport Medical Centre in Rawalpindi. For establishing this small clinic he took a loan of Rs.10, 000 from his parents. Dr. Asim recalled that he earned Rs.80 on his very first day at his new clinic and after two months he earned Rs. 53,000 which was a reasonably good amount at that time. People use to trust this doctor and his revenues began to increase day by day. Side by side he used to apply for government jobs also when his family pressurized him because they were of the point of view that government jobs are more secure and had much more added advantage over private jobs. This was what the family thinks, Dr. Asim had an alternate point of view and he never liked serving for government or any body else. He had an entrepreneurial instinct and wanted to rule people rather than people ruling him.

START OF GOVERNMENT JOB In March 1996, he got three government jobs and he joined a government health institute in G-8 sector, Islamabad. Also he used to sit at his clinic in the evening from 5 p.m-10/12 p.m. He was never happy working there, because he was posted in Pathology department in a health organization, which was not his specialty. Dr. Asim was never happy and satisfied working there because he thought that your hands are bound when you are working for some one else. On the other hand, his evening clinic was going very well and he checked even 150 patients a day. On the day he received 150 patients at his evening clinic, he thought that he don’t have the stamina to check this huge number of patients in evening only. On the very same day he took a decision that if he resigned from his morning government job and utilized that time also in his clinic then he can visit more patients at his clinic. He took a firm decision and he resigned and

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after resignation he informed his family who were a bit unhappy with his decision.

THE PAKISTANI FAMILY MODELThat was the time when the couple was blessed with a baby girl. Mrs. Asim recalled that:-

“That was a critical time when he left the job, but our basic necessities were being fulfilled because we were living with the parents of Dr. Asim”.

She further commented that parents of both Dr. Asim and Mrs. Asim were very supportive. Now Dr. Asim can fully devote his mind and energies to his clinic. So he added a laboratory and a vaccination centre in his clinic and hired another person for his help. Whatever he earned he invested back into his business. He was earning handsome revenues from his clinic but his desire to work in the area of home medical services was not being fulfilled at his clinic.

THE IDEA BEHIND IHSIn order to fulfill that purpose he established “IHS: Integrated Health Services”. He named the company “Integrated Health Services” because he practically integrated all the services in this organization. Dr. Asim remarked that:-

“My dream was never to buy flashy cars and property; rather I wanted to do something for the society”.

For doing so, he created health systems in the private sector because he thought that you can’t rely on government to do all the things. In fact government can’t do all things and people in the private sector have to do good things. He further explained that:-

“I wanted to become an employer rather to be employed”.

He convinced his family by saying that “cobbler is self employer and is responsible for his own work”.

BACK GROUND: IHSIn mid 1997, this entrepreneurial leader Dr. Asim Mahmood was successful in establishing IHS with major emphasis in providing

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services in three things namely, home medical services, laboratory services ( at the door step of clients) and school health services. The first two were his own ideas, and the third was presented by Dr. Zahid, who was school health advisor at a multilateral agency. When Dr. Zahid left his job from this multilateral agency, he suggested Dr. Asim to introduce the concept of school health services in Pakistan because it was a neglected area till then.To start with providing home services, 1000 flyers were printed, and were thrown in the houses of Sector F-8 and F-7 of Islamabad. The flyer said that if you need any kind of health services at your door step call at our help line. For details of flyer see Exhibit-2 .Dr. Asim received a phone call on the third day after distribution of flyers. The call was regarding the vaccination of Hepatitis B at a house located in sector F-8/3 of Islamabad.Fortunately, the patient was a prominent political leader and the other patient was Member of National Assembly, of Pakistan. Dr. Asim’s business broke even at the same day which fulfilled the cost of printing flyers. See Exhibit-3 for the initial receipts. With the passage of time it began to spread with the word of mouth and the business of providing home services at the patients door step started flourishing. The intensity of calls increased day by day. They were receiving calls for checking blood pressure, blood sugar and blood vaccination. At that time Dr. Asim hired a paramedic Mr. Saeed Hashmi who was the first employee at IHS. Mr. Saeed joined Integrated Health Services in the year 1997. Before joining IHS he spent 18 years in Pakistan Air Force in the nursing department. Dr. Asim chose Mr. Saeed Hashmi as a final candidate for his health centre from a long list of candidates.

Mr. Saeed recalled that:-

“Previously I was serving Pakistan Air force and working there was a straight forward thing. When Dr. Asim told me about his future aims I joined Integrated Health Services”.

Refer to Exhibit 4a for the verbatim and refer to Exhibit 4b for the video recorded interview of Mr. Saeed Hashmi.

Side by side Dr. Asim went to different schools for introducing this idea of school health services. As it was a new idea in Pakistan so it was a hard challenge to persuade the heads of schools. Dr. Asim was an optimistic person so he never loose hope.

Mrs. Asim elaborated that:-

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“Dr. Asim is very optimistic in nature; he never creates fuss or makes issue of any problem/hurdle which comes in the way rather he thinks that every problem is God given and He will provide the solution also”.

STRONG FAITH AND THE ULTIMATE BELIEF IN GODDr. Asim had strong faith on Almighty Allah, he believed that:-

“Whatever happens, either good or bad, it happens due to the will of God”.

ROLE OF PARENTS AND WIFE IN MAKING DR. ASIM SUCCESSFULMrs. Asim- being the mother of two kids is also a doctor by profession and she explained that being in the same profession was an added advantage for us because we realized the problems of each other. After the birth of baby girl she took a one year gap and then she went to school health area. Mrs. Asim wanted to pursue in surgery but as Dr. Asim was also very busy so her wife sacrificed for the sake of kids and family and pursued in Radiology. But later she left radiology and joined the business of her husband. She is very happy and satisfied with whatever she dropped out because of her children and family and had no regrets at all. As a doctor she wanted to help the society and she is contributing his share for doing so. Currently, she is doing Masters in Public Health from a private institute. While commenting about the critical times which she faced in the career of Dr. Asim, she explained that at first when he initially started his career he got three jobs in a line. But he was never willing to do government job rather he wanted to be an entrepreneur but the family wasn’t expecting the fact. But Dr. Asim persuaded his family on this government job issue. His wife remembered that at that time (and even now) whenever he talks he is very convincing so he convinced the whole family. So, after a year of government job he left that job. Although, ups and downs were there but the wife was confident enough that her husband will do something to bring the situation at a level which will be acceptable to both the families. Also, she remarked that “Asim is very good at hiding things” and

“Asim doesn’t portray the problems as problems rather he always thinks of new things”.

Mrs. Asim stated that her parents in law are very supportive and they helped them in every problem and never let them alone. Rather the father of Dr. Asim provided with good advice at every step at his career and the mother is always praying for his son’s success. Mrs. Asim explained that:-

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“I am very much privileged that we are living together (i.e. with the parents of Dr. Asim)”.

Mr. Saeed Hashmi commented that:-

“Mr. Bashir – the father of Dr. Asim has a very supporting role for the whole staff of IHS and he is a very good person”.

CONTINUOUS STRUGGLEHe struggled and worked very hard alone but continued the journey and never felt disappointed. Dr. Shahid recalled about this entrepreneurial leader and his close friend Dr. Asim that:-

“He is very consistent in nature and he never left hope although there was no success and no revenues at that time”.

He continued visiting schools and presented his idea during the year 1997 but unfortunately he didn’t get any client. He didn’t lose hope and continued his visits and got his first client in the area of school health services in 1998. Dr. Shahid recalled that in the beginning:-

“Dr. Asim used to work continuously for even 18-20 hours for establishing IHS and for making systems”.

The idea of school health services attracted the head of a private school in Islamabad. So, the first clinic at school was made whose annual charges were Rs. 250, 000 which were provided in advance by the head of the school. Another private school in Rawalpindi also took services in school health care from them.

FAMILY LIFEMrs. Asim- as a mother of two kids remarked that “we miss out in Socialization, I go on my own, unlike other couples” and further elaborated that:-

“Everybody has to do some sort of adjustment in his/her married life”.

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But, she had no regrets and commented that “Asim never made a wrong a decision”. She remarked that:-

“My career is compromised career and I have no regrets and I don’t want to put my kids at stake”. She further elaborated that” one has to set his/her role and priorities and then work accordingly on that”.

Dr. Asim is very busy individual but he never missed out the story telling part for his children at 9pm every night. Although her wife described that:-

“At times he doesn’t even remember that in which class the kids are studying in” and “Dr. Asim promotes that her daughters will run over the business in the future when the parents will get old”.

DR. ASIM AS A SOURCE OF MOTIVATION FOR STAFF AT IHSMrs. Asim commented that “Dr. Asim has been a source of inspiration for his friends” and also his way of thinking is “conviction and hard work is required for whatever you are doing”. She recalled that:- “Partnerships never suited us, we were always deceived”.

But she said that good and bad people are in every society and she gave the credit to the society by making a final comment that:-

“Whatever we are, we are because of this society”.

FAMILY FRIENDLY ENVIRONMENTThe Director projects remarked that:-

“It is the team work and family friendly environment within Integrated Health Services which is a reason behind its success”.

The Manager home medical care mentioned that:-

“It’s a family friendly environment here at Integrated Health Services”.

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There is no issue of timings as far as you complete your work and satisfy the clients. Also there is an issue of trust, Dr. Asim trust us a lot. These are the reasons which don’t let us leave IHS.

GROWTH OF HUMAN CAPITALAt that time the human resource grew to a team of 8 members in home care and a team of 8-10 persons in hospital. Mr. Saeed recalled that:-

“Dr. Asim gave me free hand and encouraged me to hire individually other male and female nurses. He trusted me to that extent that he made me accountant also. Now, I am working as Manager Home nursing care”.

The Director Projects believed that:-

“The IHS staff was working from the heart at that time”.

Dr. Asim thought to further expand his business and after entering into school health, the next target was to start home nursing care services.

START OF HOME NURSING SERVICESWhen Dr. Asim started providing home nursing services, the demand of home nursing services began to grow in the twin cities of Rawalpindi and Islamabad. Another remarkable achievement of Dr. Asim and his team was that, they successfully provided ICU- services for thirteen days, at home in a room for a female patient residing in Islamabad, who was suffering from Hepatitis-C. The lady suffering from the disease was the wife of a building contractor in Islamabad. The person took his wife to London for medical services and she remained there for sometime but didn’t get well. So the man thought to bring his wife to their home back in Pakistan, as was the desire of the couple. As the lady was a very serious patient and needed ICU- services so they contacted Dr. Asim. Dr. Asim and his team successfully provided the services at home. Dr. Shahid recalled that:-

“When we provided ICU service at the door step of a patient we provided medical instruments from thermometer to ECG machine on our own”.

Refer to Exhibit 5a for a detailed verbatim of Dr. Shahid Nadeem working currently as Director Projects. Refer to Exhibit 5b for video recorded interview of Dr. Shahid Nadeem.

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Dr. Asim hired doctors and trained ICU nurses. At that time school health and home care businesses were going pretty well, and the next target was to provide services at corporate level.

ENTERING CORPORATE SECTOR: 1998-1999By the end of year 1998 and start of 1999, Dr. Asim made proposals for different organizations like leading multinationals in oil industry and tobacco industry for providing vaccination services.

HEALTH SERVICES FOR BEACONHOUSE SCHOOL SYSTEMIn year 1999, Dr. Asim got a chance for making remarkable achievement in the area of school health services. One day he got a call from the head of Beacon House school system, Lahore to come and present about the idea. Dr. Asim went to Lahore on the call of the head of the school. He presented his idea and got the contract. The target was to provide vaccination services to all students in all branches of Beacon house school system throughout Pakistan in three months and Dr. Asim along with his dedicated and hard working team did that successfully in the provided time frame. The number of students in all branches of Beacon house school system throughout Pakistan were 52, 000, who were provided with vaccination services. Refer to Exhibit-6 for the service contract details. Dr. Asim earned Rs. 25 per child for vaccination. After that, Dr. Asim got another opportunity in the area of school health services that was to establish health system at another private school. At that time, the business was spread to providing home health care, corporate health and vaccination services.

END YEAR 1999 & START 2000In the year end 1999, Dr. Asim and his team thought to provide vaccination of Hepatitis-B to Islamabad Traffic Police. For that purpose Dr. Asim had a dialogue with ISP Mr. Nasir Durrani, who was influenced by the idea and vaccination services were provided to the whole staff of Islamabad Traffic Police. This opportunity created worth and credibility for Integrated Health Services. Also this opportunity created another opportunity. The opening ceremony of Rescue 15 was to be inaugurated on 1st January, 2000 and the IHS team provided free of cost emergency services round the clock till year 2004. Rescue 15 is a public sector organization for relief and help in the emergency, accidents, thefts and other disasters. At that time Dr. Asim didn’t had enough revenues to buy ambulances so The Red Crescent Society volunteered two ambulances to Rescue 15 where IHS team was providing free of cost services.

After that another milestone of IHS was to provide emergency medical coverage to the Development Arm of a Multilateral Agency. IHS had

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the honor, being the first to provide expatriate health services to an Embassy.

A multinational petroleum company requested Dr. Asim and his team to provide field hospital in Sindh. Later on, the IHS team also provided field clinics in the provinces of Sindh and Baluchistan. In 2002, due to time constraints, Dr. Asim sold his first Rawalpindi Hospital as a running business. Also in May 2002, IHS joined the Hashwani group and Dr. Asim provided Medical coverage to Marriott hotel, being an OPI. In May 2003, Dr. Asim resigned from Marriott Hotel. Dr. Asim is clinically a good physician and served as Chief Medical Officer for Hashu group and is providing medical services in all branches of Marriott hotel. Refer to Exhibit-8 for details of the service contract.

JOINED DISTANT LEARNING PROGRAMThen Dr. Asim applied for a distant learning program in occupational health and got membership in Finnish Institute of Occupational Health, Finland. Dr. Asim had the honor of being the third Pakistani who got this training in occupational health. Refer to Exhibit-9 for degree of Finnish Institute of Occupational Health In year 2005, Dr. Asim further expanded his business and started Research and Health consultancies, which is currently the highest revenue earning area. Dr. Asim provided National Guideline for Prime Minister Health program.

UAE RED CRESCENT CLINIC- BALALOTIHS had the honor of providing free health services in Balakot for the earth quake hitted patients. UAE Red Crescent Clinic was established in the year 2006 in the Balakot area of North West Frontier Province of Pakistan. The staff of this clinic comprises of 17 employees including two lady doctors, two male doctors, security guards, dispensers, computer operator and sanitary workers. Dr. Asim from IHS Islamabad is administrating this clinical unit and monthly record is sent to IHS, Islamabad. The doctors here are in touch with the Dr. Asim and whenever they need any help and guidance, Dr. Asim is there to provide it. Mainly the patients who come here for treatment are suffering from skin diseases and seasonal problems. The patients from Kaghan, Naran, Mansehra and Ghari Habibullah also come here for the treatment. IHS, Red Crescent Clinic Balakot has the honor of serving 1, 40,000 patients, free of charge till now. The health ministry of United Arab Emirates is providing funding for this clinic and funding for six months is provided from UAE embassy to IHS Islamabad and from Islamabad the funding is provided to this clinic. This clinic is an OPD unit and severe referral cases are transferred to Ayub Medical Complex, Abbottabad. Health advisors from IHS Islamabad come here

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for creating health awareness for the masses and seminars are arranged for that purpose. Mostly seminars related to personal hygiene are arranged for the masses. Refer to Exhibit-10 for video recorded interview of Dr.Jhangir.

MANAGEMENT HIERARCHY AT IHSIHS has 126 regular employees and the number of temporary employees varies from time to time. For the deployment chart of employees refer to Exhibit-11.

MASS VACCINATION CAMPAIGNSIn the year 1997, Dr. Asim thought to create awareness of hepatitis C in the masses, but it didn’t prove to be successful. At that time nobody else was providing these vaccination services. IHS provided vaccination services at different camps made at different places because people can’t afford to come at their centre in which vaccination service was provided. Dr. Asim made Mr. Saeed the in charge of home medical care and made a team of 4-5 people, who use to go for providing vaccination services at the doorstep of clients. Then they thought to introduce this program in different schools and colleges of Islamabad which fortunately proved very successful.Dr. Asim mentioned that:-

“I earned revenues up to 88 thousand a day during vaccination in Islamabad College for Girls F-6/2, Islamabad”.

That was the maximum revenue which he earned in this program. In other schools and colleges he earned revenue from 50-60 thousand per day at that time.

With this success, he thought to move towards corporate vaccinations for Hepatitis B, Dr. Shahid remarked that:-

“Vaccination of Hepatitis B and C and provision of health services at the doorstep of clients are the two major contributions of Integrated Health Services”.

At that time, he started the trend for vaccination registration. Uptil December, 1998 1.2 Million vaccinations were been registered, but the profit margin was very low in vaccinations. The return per vaccination was not more than Rs. 30, so he thought to quit from this business area.

QUALITY CONSCIOUSAnother reason was that many other people have entered into this business, which was using low quality vaccines imported from China.

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The group of people who were selling these low quality vaccines also contacted Dr. Asim and offered him to use the same vaccines which also had a good profit margin than the original ones. Dr. Asim bluntly rejected the offer because he believed that:-

“In medicine we never compromised on quality”.

IHS- PRACTICING ETHICAL PRACTICESDr. Shahid Nadeem mentioned that:-

“No other organization is working like Integrated Health services with ethical practices and standard operating procedures”.

Currently, I am working as Director Projects. When IHS was established, there was no competition at all. Unique services at the door step of clients were being provided at that time from the platform of IHS. We use to take very low profits for superb services which we provided, because at IHS we can’t compromise at quality. Our motto was:-

“Client satisfaction no matter if we were getting low revenues. The purpose behind the establishment of IHS was not to make money but to provide quality service”.

Dr. Ali Raza acknowledged that:-

“IHS believes in making systems and efforts should be done to meet standards”.

DECEMBER 2002: INITIATED TRAININGSIn December 2002, the business volume of IHS was getting low, so in May 2002 Dr. Asim took a decision to join a leading company in the oil sector. Also he thought to start providing trainings of first aid in corporate and school level and consulted Pakistan Red Crescent Society for that matter. Dr. Asim and his dedicated team launched a program known as “FATS” abbreviated as First Aid Training for Schools. The duration of the training was six hours. Dr. Asim, himself was the master trainer and he trained his staff, so that they will be able to provide trainings at different schools. A contract was made and duly signed by IHS and Pakistan Red Crescent Society that they will provide combined trainings in all schools of Pakistan. They were

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charging Rs. 250 per student in some schools while in some others the charges were Rs. 300 and Rs. 400. It was decided in the contract that Rs. 2000 per training will be given to Pakistan Red Crescent Society. But, after two, three months the head of Pakistan Red Crescent Society ended the contract. Later on, the first aid trainings were provided solely by IHS. As the profit margins were low in schools and colleges so Dr. Asim thought to shift to corporate sector for the same trainings.

CORPORATE SECTOR: FIRST AID TRAININGSEntering the corporate sector with this thought proved very successful. The first call came from the Development Arm of a multilateral Agency. IHS charged Rs. 25,000 for providing first aid training to the staff of this agency. After successfully delivering the trainings at this agency, the next client was a leading multinational in the tobacco sector. The first aid trainings for this tobacco company were provided at its different factories in different cities. This was a major hit for IHS and the top management at this leading tobacco company was very much impressed from Dr. Asim and his team. The top management asked Dr. Asim that what other service they can provide to them. Dr. Asim said that IHS can provide you trainings in occupational health, general health and ergonomics. Also the top management requested Dr. Asim to assess their tobacco factories and report to them what were the deficiencies and loop holes. Dr. Asim did the same and reported to top management. Dr. Asim gave a proposal of worth 1.8 Million and it was decided that trainings in general occupational health (for factories workers and office staff), ergonomics trainings (for office staff only) and first aid trainings for both will be provided in one year. Dr. Asim and his team not only provided the trainings but also gave recommendations to this tobacco company. This tobacco Company remained a client of IHS from year 2003 till now. Also side by side Dr. Asim was providing trainings in occupational health in different oil companies. Another client for trainings in the corporate sector was a multilateral agency working for labor relations. A doctor from this agency contacted Dr. Asim and requested to provide trainings in stress management. This was a 4-5 day training session which was provided in a Continental Hotel, Bhurban. Dr. Asim earned Rs. 75,000 per day from this training. The top management of this agency was also present in the training session and they felt very happy and satisfied from the training.

COMPENSATIONThe Manager home medical care being the very senior employee at integrated health Services remarked that:-

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“He gives us (the IHS staff) handsome salary plus a

yearly increment in pay. Also if any body among the staff needed any sort of financial help he provided us that, even up to hundred thousands in the hour of need”.

RESEARCH AND CONSULTANCIESAnother vital area in the operations of IHS was research and consultancies. Dr. Asim had the honor of providing National Health Guidelines for the Prime Minister program for viral hepatitis case management. It took two years for the whole activity because the gastronologists all over Pakistan were called and after discussions and workshops consensus was made and then the guidelines were produced.

COMPLETE HEALTH CARE FOR CORPORATE SECTORAfter that, another milestone of IHS under the supervision of Dr. Asim was that they thought to provide complete health care requirements to different companies. Dr. Asim made a complete list of areas in which they can provide health care services in the corporate sector. The list includes the following areas:-

Managed health care ( IHS was pioneer in introducing this concept)

Training services Creating health awareness Arrangement of hospitals on panel for employees Claims verification of medical bills Rescue and emergency care for employees based in Rawalpindi

and Islamabad Providing health policies Acting as health contractors ( IHS was pioneer in this field, and

was providing health contracting services in oil field in oil companies)

While acting as health contractors, IHS sent his doctors to the oil fields in Oman also.

DELEGATION OF RESPONSIBILITYMany other companies also contacted IHS for trainings in stress management and Dr. Asim and his dedicated team provided those trainings. In all these trainings Dr. Asim himself was the master trainer, as the load of trainings were increasing day by day and Dr. Asim felt that he cant provide all the trainings himself, because he also had other tasks to do .

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So he hired another doctor, Dr. Alamgir who took charge of providing first aid trainings from year 2005-2008. But, Dr. Asim still needed other trainers so he started building teams of trainers. He believed that :-

“The company had the base and the trainer had the skills which makes training successful”.

Whenever Dr. Asim hired a trainer for providing trainings in a particular area, he decided to pay them one third of the revenue which IHS will earn.According to Dr. Asim, running an organization is not a “one man job”. He had this concern that what will happen if one day he will become ill, then who will run after the whole business. He believed that good, loyal, honest and sincere people are required for doing this business. He remarked that I have handed over the charge to other loyal doctors for the F-10 children hospital and things are going well this way. He gave the credit to Dr. Ali Raza and Dr. Shahid Nadeem for running successfully the children hospital. He delegated responsibility to other individuals who are loyal and honest. While delegating responsibility Dr. Asim came out of the day to day operations and he is at the strategic and planning level now.

LOOSING MONEY BUT NOT SYSTEMSDr. Asim made directors for running the various segments of the business. He commented that:-

“I would loose money but would not loose systems”.

For him, systems which he made matter a lot rather than money.

I-8 INTEGRATED HEALTH SERVICES HOSPITALI-8 Integrated Health Service centre is basically a satellite facility and the OPD sector which runs from 9am to 9pm. Dr. Ali Raza being the Director Charge and Services is responsible for the operations of I-8 IHS centre, F-10 Children Hospital and school health.

DR.ALI RAZA -DIRECTOR IHS CHILDREN HOSPITALDr. Asim had a children hospital in the posh area, F-10 of Islamabad. The hospital broke even after three months. Dr. Ali Raza being the Director of Integrated Health Services Children hospital F-10 Islamabad commented that the idea of this unit stemmed from the need. Roughly out of every hundred (100) people 45-50% comprised of children who are less than 15 years of age. For catering the health needs of children government hospitals are there but there are a limited number of beds for children and quality health services are also not provided to them. So, as the aim of Integrated Health Services is to help the society and create health awareness in the masses. They thought to establish a

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sub branch of IHS and name it is IHS- Children Hospital and this unit is located in the posh area of Islamabad. IHS Children Hospital is a year plus now. The environment of the hospital is made keeping in view the psychology of the children. Refer to Exhibit 12 for the video recorded interview of Dr. Ali Raza for details of thematic rooms.

Time Duration 1st quarter 2nd quarter 3rd quarter CurrentlyNo. of Patients 400 600 1000 > than 3500


HELPING THE POOR AND NEEDY CHILDRENFree of cost health services are provided to the poor and the needy children at this service unit. A charity profile is made for such type of needy children. The health of a child is not compromised in any way no matter whether the needy child’s parents had paid for the service taken or not. FEED BACK SYSTEMA feed back system is maintained in this children hospital and according to this feedback system the satisfaction level of the clients is 100%. Parents are very much satisfied from the services which are provided here. Also the response time is very quick here. Doctors and other medical staff gave the patients enough time and enough care so when the parents leave the hospital they are very much satisfied for two reasons. First reason is that their ailing child is cured now and secondly the doctors and staff treated them very well. Also follow up calls are made, a day after the child is discharged from the hospital just to inquire about his/her health. All the parents which come here for the treatment of their child are referred either by their friends or relatives. So, the promotion of this health centre is mostly done by word of mouth.

ROUND THE CLOCK HEALTH SERVICESThe very unique thing about this centre is that it provides 24-hours health services to the patients. There are two shifts of doctors whose contributions are the reason behind the success of this hospital. One is the IHS staff and the other is the visiting staff present at this centre. The IHS staff is the permanent staff which serves here round the clock in shifts of eight hours. Among the visiting staff two doctors are always present at the centre for serving the society. Two files are maintained for the record keeping of every child. One file is maintained in the hospital record and the other file with complete information is handed over to the parents of the child. So, the health services provided at this hospital are very much personalized services.

CLIENTELE IMPACT

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The Director Projects at IHS remarked that:- “Dr. Asim doesn’t have a bossy attitude at all rather his emphasis is on services provided to the clients”.

Our ultimate aim is that:-

“Task should be fulfilled and client should be satisfied, the environment is not tensed here like other organizations. I own everything here at IHS and I work independently and no matter how big offer I get from outside world I will reject that for the sake of IHS”.

The mother of Ms. Salma Khan is a client of Integrated Health Services from the last ten years. Ms. Salma commented that:-

“My mother is old and ill as she can’t walk and communicate so I am availing the home care services from HIS since their beginning and I am a very satisfied client. They provide twenty four hours medical services and when you call them its like a hospital coming into your home. They know me and my mother very well and I know them very well. I have confidence in them as I have crossed many bridges with IHS because of my mother’s illness”. The lady was so much impressed and satisfied from their home care services that she is writing a book named as “Hand on a shoulder” on her experiences with her ill mother and the services which should be provided to such kind of patients. The book is based on her personal experience and once it is completed it will be distributed free of cost. Refer to Exhibit 13a for the video recorded interview of Ms. Salma Khan.

Dr. Tariq is working as a health advisor for a large multinational company in Islamabad. As a health advisor they are availing the services of Integrated Health Services for their multinational. Dr. Tariq is responsible for the clinical and personal health of all employees at his company. He remarked that the number of reasons for which we chose IHS were:-

IHS has better infrastructure Requisite experience of working with other

multinationals Worked in the area of school health care Worked voluntarily during earth quake IHS – being the pioneer in their work Are trust worthy and have a very good team

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IHS provided first aid trainings to our employees and also is looking after the vaccination services of our employees. Also they gave trainings to the staff of this multinational company to make better use of office equipment. Dr. Tariq another satisfied client commented that:- “Very few people are there, who have worked in the area of ergonomics and Integrated Health Services is among one of them”.

Refer to Exhibit 13b for the video recorded interview of Dr. Tariq.

GLOBAL FUND FOR AIDS, TUBERCLOSIS AND MALARIAAnother remarkable success of this entrepreneurial leader was working in a health project which was funded by a multinational working under health sector. Third world countries are funded by this multinational .So, in round six for Tuberculosis Dr. Asim applied for the fund for creating awareness in school children. The program under this multinational was to make school children as ambassadors in their communities. The function of these ambassadors will be to create awareness in their communities regarding tuberculosis. Dr. Asim remarked that:- “There are eight things which are of vital importance which should be known to people in rural areas”. The purpose of establishing school tuberculosis club was to promote volunteerism in students. School tuberculosis club is a five year nation wide program and is first of its kind in Pakistan. Currently this program is working in ten districts of Pakistan but it can be spread across all over Pakistan, because it is scalable and extendable program.

HEALTH RADIOThis idea focused and innovative entrepreneur leader had another milestone coming in his way which is the concept of Health Radio. Dr. Asim made a concept paper for this project. This project basically talks about a twenty four hour live radio transmission for providing medical health advice to the masses. This Health Radio will basically provide two major functions:-

Health talks by specialist doctors To provide emergency health services

Currently, work is being done on this project with the financial assistance of a developing agency working under a multilateral organization. This project was made to serve the whole country but currently a pilot program is being aired on local radio station FM 88 in district Chakwal only. It will be a half hour Radio program which will be aired thrice a week. Three people will be involved in this radio program namely an anchor, a gynecologist and another medical specialist. These radio programs are meant to serve the purpose of creating awareness and providing medical advice to women in their child

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bearing age. Also for providing emergency services the mapping of Chakwal city is being done by this developing agency. The budget required for this activity id $ 8.2 Million. In the year 2009 twenty percent financing will be provided by Dr. Asim and the rest eighty percent will be provided by this developing agency. The pilot program will be run in Chakwal city only, and time buying is made from FM 88 but a proper radio station is required in order to serve twenty four hours of medical health and advice. For that purpose Ministry of Health, IHS and this developing agency have joined hands together and made a consortium and have applied for a radio channel license from the license issuing authority, PEMRA.

ROLE OF DR.ASIM IN MAKING IHS SUCCESSFULDr. Tariq (the health advisor of a large multinational being the client of IHS) had the view that:-

“I know Dr. Asim for a long age, he is a very good physician, and I found him committed for whatever he is doing. He has a vision and he is working rightly for the achievement of that vision. Also he tries to work in a better environment for the betterment of the people of his company and he is going to achieve that one day .Asim is a kind of person who works very hard and in his case I must say “Persistence always pays” ”.

Commented by Dr. Tariq

A very satisfied client who is availing health services for her mother from the past ten years said that:-

“I respect his diagnostic and clinical ability. As a doctor he is brilliant. There are a lot of good people working in this country who are working for the betterment of the society. I think it’s a wasted life if you don’t help others in the hour of need”.

Commented by Ms. Salma KhanDirector Projects stated that:-

“Dr. Asim is stick to the same business from day one with the same zeal and motivation. He never left IHS, although he got many offer from abroad also”.

Commented by Dr. Shahid Nadeem

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Director IHS children hospital believed that:-

“Asim had a novel way of doing things. He brings into reality his imagination”.

Commented by Dr. Ali Raza

Manager Medical care and being the most senior employee of IHS stated that

“Dr. Asim don’t have any bossy attitude. We have no fear of him, he is like my brother. He says me, “you are my elder brother”.

Commented by Mr. Saeed Hashmi

“Dr. Asim is a very good administrator”

Commented by Dr. Jhangir

TRAINING BUISNESS

Training business is going down due to the economic conditions in the country. The organizations which require first aid, fire fighting and disaster management trainings now negotiate at the cost at which the training is provided.

SCHOOL HEALTH

On the other hand, business in the school health sector was going very well. Currently IHS is working as the market leader in school health area.

“Now after almost 10 years in school health IHS is a market leader in provision of various types of health services to the educational institutions in Pakistan. Due to our commitment and non-commercial and professional approach IHS is the largest operator of school health in the country with

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over 0.8 million students enrolled so far and 223,180 current registrations (till June 2007) “.

Mrs. Asim, being the life cum business partner is running the school health area of the business.

EMPLOYEES FEEL A SENSE OF OWNERSHIP

Dr. Shahid Nadeem believed that “-

“Everybody feels a sense of ownership and this particular feeling does not let us leave Integrated Health Services, although we have options but we don’t want to avail them”.

The Integrated Health Services staff worked with Dr. Asim, free of cost even at the time of need. An era came, when Dr. Asim called a meeting and commented:-

“If you are willing to leave IHS you can go, but nobody left Dr. Asim at that critical time rather the staff worked free of cost with him”.

LIFE TIME CONTRIBUTIONS FOR IHSDr. Asim gave the credit to his parents and wife for their endless support which they provided to him are still providing. He mentioned that:-

“I worked for even 18-20 hours continuously but they never complained”.

The struggling life of Dr. Asim talks about a Pakistani model of working in which the support of parents and wife matters a lot.He thinks that the following successful events are a milestone in his career:-

Dr. Asim considered the setting up of ICU service as being a milestone in his career path. That successful setting of ICU service enabled the newly established business to enter into home care with full power.

Another successful event which he will never forget is entering into school health business.

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NEED FOR PROMOTING HEALTH SERVICESWhatever work has been done in the last 13 years since the establishment of IHS till now, 75-80% things have worked only 20% things failed. Dr. Asim is so much optimistic in nature that he is even happy and satisfied on the failed things because he said that at least I have worked and tried no matter I failed. He thought that there is a strong need for promoting health services in the country. The life of Dr. Asim is an emblem for the masses, depicting that there are individual who are brave enough and have the power to work for the betterment of their country no matter how many hurdles come in their way and how worsen the situations may be. Dr. Asim had this view that “there is a consumer every where” and the economic conditions of the country does not matters a lot. He gave the example that people are making a handsome amount of money even in Afghanistan. Dr. Asim believed that a lot more has to be done in health sector of Pakistan. A good amount of aid is also coming to our country but unfortunately, that aid is being misused. He remarked that:- “I wish that the aid is used properly at the right place”. The Director Projects had this vision that in the future they will spread this home care service to other cities like Karachi and Lahore.

FUTURE OF IHSThe key to success is to remain consistent and moving forward, without regretting at the losses. He had this view that if you have the will to do something for the society and for the sake of your country then you can easily accomplish your tasks, no matter how worsen is the condition of the country. He said that it also depends in the industry in which you are working. People can’t compromise on their health no matter how bad the economic conditions are in the country. Every body is concerned about his health and wanted a better treatment. Over the last one year, things have changed a lot. In Pakistan businesses are going down and large lay offs have been made. But, Dr. Asim believed that:-

“Health is a sector which will never go down, because everybody is concerned about his health and can’t compromise on it”.

In Pakistan, Dr. Asim was a pioneer in providing health services but he is now going to try his luck in United Arab Emirates. The critical factors

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which should be kept in mind before going there could be that, Are there people present in UAE who are already providing this kind of services at schools? Will they welcome the school health services provided by Dr. Asim and his team? How will he convince the head of schools there? Do they really need these services?

Exhibit -1BUISNESS OPERATIONS

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Figure 1: Showing business operations at Integrated Health Services


EXHIBIT- 2

DETAILS OF FLYERSEXHIBIT- 3

INITIAL RECEIPTS

EXHIBIT- 4a VERBATIM OF MR. SAEED HASHMI

Mr. Saeed Hashmi – being the very old employee of IHS is working currently as Manager Medical care. In the beginning, I joined as a screening and vaccination officer. Also, Mr. Saeed recalled that there were some old and needy patients who required our home care services for checking blood pressure and temperature. Integrated Health Services was pioneer in providing such unique services at homes of clients. A file is maintained for such older patients and as IHS was providing 24- hour’s service so some old patients avail their services during night time and some patients used to avail health services during day time.

HELPING THE POOR AND NEEDY Dr. Asim is a generous, humble and down to earth individual. He helped the poor and needy patients from his own money. There are 8-10 patients who are provided with five thousand per week for the sake of their treatment. He is always in search of good, honest and loyal people who can contribute in the society by becoming a part of Integrated Health services. Dr. Asim had a very good team which is also a reason behind his success.

EXHIBIT- 4b VIDEO RECORDED INTERVIEW OF MR. SAEED HASHMI

EXHIBIT- 5a VERBATIM OF DR. SHAHID NADEEM

Dr. Shahid Nadeem- a friend and class fellow of Dr. Asim Mahmood did his M.B.B.S from Rawalpindi Medical College, Rawalpindi in 1992. Then

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he did his house job and ended that in 1994. Dr. Shahid did his MCPS in family medicine and established a clinic in Faizabad. As both Dr. Asim and Dr. Shahid were class fellows and friends so they were in touch with each other. Dr. Shahid was getting fewer patients at his private clinic so he was a bit worried. Dr. Asim asked Dr. Shahid to join IHS in the evening time while continuing his private practice in the morning at his Faizabad clinic.

Dr. Shahid was persuaded by this unique idea of Dr. Asim of establishing a health centre named as Integrated Health Services, so he joined him. As the idea was very novel also there were no competitors at that time. Dr. Shahid left IHS in 1999 for doing MCPS and winded up the set up of Faizabad clinic. He again joined Integrated Health Services after his specialization. At that time, both the friends established the home care services.

Dr. Shahid left IHS and joined Shifa International Hospital, Islamabad with a good salary package. Due to some family constraints Dr. Shahid resigned from the Shifa International Hospital and again joined Integrated Health services. Dr. Shahid got an offer from Saudia Arabia and went abroad. After 2.5 years, he again resigned from the job and came back to Pakistan due to family problems. Dr. Asim again offered his friend Dr. Shahid to join Integrated Health Services. It’s been three years now, I am working for IHS after returning from Saudi Arabia. Dr. Shahid stated that “I am Director Projects now; previously I worked as Director Home care”. He commented upon the need and scope of Public health Dr. Shahid stated that “Public health and family medicine has scope and I privately did Masters in Public Health”.

I see myself growing in Integrated Health Services 8-10 years down the road. Our health business will remain the same; we have no threats in this area.

EXHIBIT- 5bVIDEO RECORDED INTERVIEW OF DR. SHAHID NADEEM

EXHIBIT- 6 SERVICE CONTRACT WITH THE SCHOOLExhibit-7 SERVICE CONTRACT WITH MARRIOT HOTEL Exhibit-8 DEGREE OF FINNISH INSTITUTE OF HEALTH Exhibit-9

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VIDEO RECORDED INTERVIEW OF DR. JHANGIRExhibit-10

MANAGEMENT HIERARCHY AT IHS

Exhibit-11THEMATIC ROOMS

The environment of the hospital is very soothing and relaxing. The children are not frightened from the hospital because their favorite stuff toys are placed every where in the hospital. The rooms in which the children are admitted are known as “thematic rooms” rather named as “room #1, room #2” and so on. There are basically three thematic rooms named as the “blue”, “yellow” and “purple” thematic rooms. The yellow thematic room has yellow bed cover, yellow wall paper and yellow stuff toys which are made just to ease out the child and the child feels at home in this scenario. The children who come for regular check ups are provided with gifts by the doctors. These presents are bought by the doctors themselves from the market and the busy doctors have to take out time for this activity from their busy schedule. These gifts include story books and stationery items like pencils, colored markers, coloring pencils, sharpeners and erasers etc.

BIRTHDAY REMINDERSApart from this, a profile is maintained for every child and birthday reminders are sent to the children. The children whose vaccinations are due are given reminders a day or two days before from the hospital staff.Exhibit-12a

VIDEO RECORDED INTERVIEW OF MS.SALMA KHAN

Exhibit-12bVIDEO RECORDED INTERVIEW OF DR.TARIQ

Exhibit-13 MISSION STATEMENT

Provide quality healthcare through integrating professional services, focusing on immediate attention, prevention, detection, and early

correction, in a manner affordable for every oneHelp in developing a society that is health conscious and prepared to face threat of any disease that it may face now or in future through

health education, research and trainings

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Reduce the sufferings and costs associated with morbidity and mortality by better and immediate health care, for individuals, groups,

and societyInitiate and implement strategies in the health sector that are

innovative, quality oriented, focusing on the needs that cover all spectrums of the corporate sector & the society in general

Source: Company documents

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