30 October 2025
Authors: Sriteja Reddy Wudaru, Andrea Prencipe
Abstract:
In Jupiter, a leading international hospital in Southern India, around 20 cardiac physicians share two “Catheterization Laboratories” to perform interventional cardiac procedures for patients. Jupiter’s management has designed a schedule that allocates the labs in 1- or 2-hour slots to different physicians at different times on different days. Additionally, they have also appointed a coordinator to ensure the physicians respect the schedule and to manage any discrepancies that may arise. Because only 2 labs are present, a physician can perform a procedure only if another physician already using a lab hands it over on time. But these hand-offs never go according to the plan because of a few reasons. Jupiter implements a unique fee-for-service business model. It does not pay physicians a fixed salary; instead they earn a fee for seeing patients in their “out-patient” offices, and a share in the amount earned through interventional procedures. To balance procedures and out-patient office, physicians often put their patients in the lab and go back to their out-patient offices. The lab remains blocked and other physicians cannot use it.
This derails everyone’s schedule within and beyond CCL. Physicians also plan their procedures in ways that benefit them without any concern towards others’ work. Additionally, the interpersonal competition amongst physicians has put pressure on them to appear superior to their peers. They try to highlight their own skills or defame or trash-talk about others. As more and more physicians engage in such behaviors, even those who joined the hospital recently think this is legitimate and acceptable behavior. There is also a lack of loyalty towards and identity with the hospital as physicians work in other organizations too. As they can leave taking their patients with them, Jupiter’s top management is reluctant to impose sanctions on the physicians for not following the rules. As a result, frequent tensions occur amongst physicians who often resort to arguing and even fistfights. The coordinator often tries to resolve these conflicts through various tactics but no concrete solution seems to be possible.
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