As Chairman and Founder of Narayana Health, cardiac surgeon Dr. Devi Shetty is changing the face of health care in India, ensuring that those in need of surgery receive it – whether they can afford it or not.

While many in the Western world grumble at the routine of an eight-hour work day, five days a week, 61-year-old Dr. Devi Shetty’s working day often lasts up to 18 hours — and he does it with a smile.

I see about 60 to 80 heart patients and do at least one or two major heart operations a day. In between, I might give a presentation to some business schools or conferences over Skype.

After qualifying as a cardiac surgeon at London’s Guy’s Hospital, in 1989 I started my career in Kolkata, where two things happened that influenced me deeply. First, although I would see 100 patients every day, I realized that none of them turned up for heart operations because they couldn’t afford it. And second, I met the inspirational Mother Teresa when she became my patient. She taught me a lesson: hands that serve are more sacred than the lips that pray.

I soon realized that charity is not scalable. Irrespective of how wealthy you are, if you are going to give something for free, it’s only a matter of time before you run out of money. I was inspired by Henry Ford’s production of the Model T: he reduced the cost of the car so that the majority of Americans in the 1930s and ’40s could afford one. I thought these business principles could be used in a hospital.

There is always skepticism when you start something new, and we were shaking the

foundations of health care delivery. But we believed in it, and it is desperately required because our customers don’t have the privilege of debating whether they want to buy our service — if they don’t, they will die. So, with a bit of time, we were able to prove that what we were trying to do worked and that a significant number of people were benefitting. We wanted to build a 300-bed super-specialty hospital and equip it for US$6m, 25% of the average cost, and we wanted to build it in six months — it would usually take three years. We contracted India’s largest construction company, and we managed to do it.

Leveraging economies of scale, we are reducing the cost of surgery. We would like to add 30,000 beds in the next 7–10 years and reduce the cost of heart operations from the current price of US$1,500 each to about US$800. This year, we will open our cardiac unit in the Cayman Islands, and we are looking at expanding into other countries in Europe and Africa, where we are currently searching for strong local partners.

Charity may not be scalable, but good business principles are. Narayana Health uses sound business principles for efficiency, better outcomes and lower cost. We invested heavily in technology to ensure we get strong data.

Every day, by midday, senior doctors and administrators get an SMS on their mobile phones with the previous day’s financials. For us, looking at the profit and loss account at the end of the month is like reading a post-mortem report, whereas seeing it on a daily basis is a diagnostic tool — you can take remedial measures.

The next generation is buying into the Narayana Health way of care, and we are training young doctors through the Doctoring the Future: Udayer Pathey program in West Bengal. We need to invest in children from deprived backgrounds — they have compassion and a fire in their hearts that will turn them into outstanding doctors.

It always helps when the next generation believes in what you want to do, when they are passionate about changing things and making it better. It reassures you that all the dreams and aspirations you have will not die with you. My kids strongly believe in what I do, and my family are all involved in the business.

My older son is a graduate from Stanford Business School; he had an opportunity to do whatever he wanted. He’s a very bright kid, but he decided to come back and work with me. And my other two sons are doctors: one is doing cardiac surgery residence, and the other one wants to become a cardiac surgeon.

For me, there is no question of slowing down or retiring. It’s very important that, for as long as God gives you the strength to work, you should work. You shouldn’t decide based on your age. Work for me is not an effort, it’s a joy, and I’m a person who is blessed with virtually everything a person my age wants. It’s not philanthropy or a charity: it’s my duty.