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7.1
The Reluctant Administrator
The Unsolicited Crown
In September 2009, the trajectory of my career shifted without warning. I was a Professor of Medicine, content in my familiar world of wards, rounds, students, and research, when a letter arrived from Dr. (Mrs.) P. Narang, the Secretary of the Kasturba Health Society. It was brief, formal, and decisive. I had been appointed Medical Superintendent of Kasturba Hospital.
I read it twice, as if a second reading might change the meaning. It did not. I remember feeling two emotions at once—apprehension and a faint, helpless amusement. The management had sanctioned a “special allowance” of ₹500 per month for the post. Even in 2009, it was a token amount, almost ceremonial, and it made me smile for a second. Then the smile vanished. The sum felt inversely proportional to the headaches I knew the job would bring.
The vacancy had opened because of a regulatory technicality, the kind that looks harmless on paper but rearranges lives. Dr. K. R. Patond, our Orthopaedic Surgeon, had been running the hospital with calm efficiency. But the Maharashtra University of Health Sciences (MUHS) enforced a strict rule: one person could not hold two administrative positions simultaneously. Dr. Patond had to choose between being Head of Orthopaedics and Medical Superintendent. He chose his department—understandably—and the superintendency landed, with quiet inevitability, on my table.
I had not applied for the post. I had not lobbied for it. In truth, I had spent most of my career avoiding it.
A Chair With Shadows
My hesitation was not only about workload. It was about legacy.
To sit in the Medical Superintendent’s chair in Sevagram was to step into the long shadow of giants. Kasturba Hospital had been steered by stalwarts whose names were spoken with respect in corridors and committee rooms: Dr. P. Nayar, Dr. Karunakar Trivedi, Dr. O. P. Gupta, Dr. R. Narang, Dr. V. N. Chaturvedi, Dr. A. P. Jain, Dr. S. Chhabra, and Dr. Patond. They were administrators of a different era—firm, authoritative, and unembarrassed by power. They could still a room with a glance. They could resolve a crisis with one sentence.
I was not cut from that cloth. I was a physician who preferred the bedside to the boardroom, the patient’s story to the committee’s agenda. I had always believed that the best decisions in medicine are made close to the patient—where breathlessness can be seen, not merely described; where pain is not a complaint but a face.
Administration, to me, was a different world: files, permissions, budgets, politics, and meetings that began late and ended later. It was not that I looked down on it. I simply felt it was not my habitat.
Twenty-Four Hours
The letter gave me little time. I had barely twenty-four hours to respond. In Sevagram, decisions like this are rarely made slowly. The hospital runs on urgency; even leadership changes must not interrupt the rhythm of admissions, deliveries, emergencies, and ICU alarms.
In that narrow window, I did what many people do when they are unsure: I called someone who would tell me the truth without sugar-coating it. I rang up Dr. Rajnish Joshi, a close colleague and a friend whose intelligence I trusted and whose humour I had learned to respect.
He listened quietly and then said, “My condolences.”
I laughed, because it was funny. I also laughed because it was accurate.
Rajnish assumed—perhaps correctly—that a man like me, shaped by academics and clinical medicine, would not survive the friction of administration. I assumed the same. In my mind, I would do my duty for a few months, endure the chaos, make some improvements if I could, and then retreat gratefully to my ward rounds and postgraduate teaching.
I could not have been more wrong.
I remained in that chair for twelve years. The post I had accepted reluctantly ended up defining the second half of my professional life.
The Nature of the Beast
I learned early that the Medical Superintendent’s job in a teaching hospital is a paradox dressed as a title.
You are expected to lead, yet you are constantly negotiating. You must speak for the faculty, the residents, the nurses, the technicians, the clerks, the patients—and still remain answerable to the Society, the Board, the auditors, and the budget. In one hour you might be discussing ventilators and ICU mortality, and in the next you might be arguing about a broken autoclave, missing linen, or a water tank that refuses to fill.
A superintendent must be a visionary one moment and a plumber the next.
Unlike the President of the United States, who is granted the luxury of “the first 100 days,” a Medical Superintendent gets no honeymoon period. The judgment begins on day one, often before you have learned where the keys are kept. The hospital does not slow down to accommodate your learning curve. The emergency does not wait. The OPD does not shrink. The wards do not become quieter out of sympathy.
And success in administration is a peculiar thing. In clinical medicine, you aim for cure, or at least relief. You can measure improvement in blood pressure, oxygen saturation, fever chart, appetite, sleep. In administration, you measure success by the absence of catastrophe. The day goes well if nothing collapses—no oxygen crisis, no violence, no sudden shortage, no scandal, no strike, no headline.
It is like financial planning: wealth is often built not by spectacular gains, but by avoiding ruinous losses. In a hospital, too, you are constantly trying to prevent the one mistake that can undo years of goodwill.
A Manifesto in an Email
Yet once I accepted the role, reluctance could not be my personality. If I was going to sit in that chair, I needed to set a tone—at least for myself. I did not want to become a caretaker who merely signed files and attended meetings. I wanted the post to remain anchored to what mattered most: patients.
On September 4, 2009, I sat down and wrote an email to Mr. Dhirubhai Mehta, President of the Kasturba Health Society. It was not a formal acceptance letter. It was closer to a manifesto—my attempt to define what a hospital should mean, and what kind of superintendent I hoped to be.
From: Dr. S. P. Kalantri
To: Mr. Dhirubhai Mehta
Date: September 4, 2009
Subject: On taking charge
Dear Dhirubhai,
May I thank you for the wonderful letter you wrote asking me to look after our hospital.
Managing a hospital is a challenging task. It gives one a unique opportunity to introduce changes that could positively influence the way health professionals function. Incidentally, the word “hospital” comes from an old French root which originally meant shelter for the needy. Curiously, the words hospital, hostel, hotel, and hospice owe their origin to the same root—each indicating a place that offers succour.
And yet, if public perception is anything to go by, given a choice, nobody likes to stay—let alone visit—a hospital. Hospitals evoke pain, stress, fear, uncertainty, and insecurity. A good hospital is one which responds not only to the explicit concerns of patients, but also to the unvoiced ones, and tries to make their visit a little more pleasant.
Today’s New York Times reports that Johns Hopkins Hospital was ranked as the best hospital in the US because it received the highest scores for quality and efficiency. Of the 100 hospitals judged, compared with the poorest performers, the best-performing quintile had 25% lower death rates, 19% fewer medical complications, and 13% fewer patient safety incidents—even though their patients were sicker and their average hospital stays were significantly shorter. Researchers looked at five metrics that gauge clinical quality and efficiency: death rates, medical complications, patient safety, the average length of stay, and adherence to clinical standards of care.
Not an easy task to achieve these standards in our setting. But that should not deter us from trying. I am on a learning curve right now and hope to learn quickly the tips and tricks that good managers use to make hospitals more professional and patient-friendly.
Thanks once again for your trust and confidence. I hope to meet your expectations.
With regards,
SP
When I read that email now, years later, I can see my nervousness hiding behind formality. I can also see something else: a stubborn hope. I was telling Dhirubhai—and perhaps telling myself—that even in a rural hospital with limited resources, we could still aim for quality, dignity, and trust.
I did not know then how many times that hope would be tested. I only knew this much: the chair was mine now, and the hospital was waiting.