The healthcare sector has a peculiar problem. Unlike engineering schools that churn out engineers or business schools that produce MBAs, hospitals struggle to find leaders who understand both medicine and management. This talent gap has become acute in India’s rapidly expanding private healthcare market, where clinical excellence must marry commercial acumen.
CARE Hospitals, a chain of 17 facilities across six Indian states, believes it has found an answer. Rather than poaching seasoned executives from other sectors, the company has built what it calls an internal “farming” system—recruiting fresh graduates and moulding them into healthcare leaders over years of structured development.
“Over my years at CARE, we’ve had a fairly described talent-management structure. In the last couple of years, we’ve become very serious with that,” says Amit Singh, CHRO, CARE Hospitals.
The structural challenge
The problem runs deeper than mere recruitment. Traditional hospital hierarchies are notoriously flat, with individual hospital heads reporting directly to chief executives. This creates what Singh calls a “succession crisis”—if the CEO departs, there’s no obvious replacement waiting in the wings.
“Over my years at CARE, we’ve had a fairly described talent-management structure. In the last couple of years, we’ve become very serious with that.”
Amit Singh, CHRO, CARE Hospitals
CARE’s solution has been to restructure entirely. The company has introduced zonal heads managing clusters of three hospitals, regional heads overseeing six facilities, and then the CEO. This expanded the leadership team from one person to seven, creating what Singh describes as a “natural progression ladder.”
The approach appears logical, though it raises questions about whether such layered management might slow decision-making or increase costs. Singh insists the benefits outweigh potential inefficiencies: “From a one-person structure, I now have a seven-member leadership team. Already, two internal employees have moved into zonal roles.”
Farming versus fishing
CARE’s “farming” philosophy centres on recruiting directly from universities rather than hiring experienced lateral candidates—what Singh calls “fishing” in the market. The company targets graduates who may lack healthcare backgrounds but demonstrate adaptability and what he terms “service mindset.”
This strategy reflects a broader shift in corporate thinking about talent development, though it’s not without risks. Training fresh graduates is expensive and time-consuming, with no guarantee they’ll remain loyal once skilled. When pressed on this concern, Singh points to declining attrition rates over three years as evidence the approach works.
The company has also embraced what Singh calls “zigzag careers”—encouraging employees to move laterally between departments. Operations staff have shifted into finance roles, whilst communication specialists have taken on branding responsibilities. “Twenty years ago, if somebody started in HR, he died in HR,” Singh notes. “Today, careers are ‘zigzag’.”
This flexibility sounds progressive, but critics might argue it could lead to jack-of-all-trades managers who lack deep functional expertise. CARE counters that such breadth prepares leaders for senior roles requiring cross-functional understanding.
The great manager experiment
Perhaps CARE’s most ambitious initiative is its “Great Manager Programme,” designed to transform individual contributors into team leaders. The programme operates in two phases: personal effectiveness for new managers, and team leadership for experienced ones.
The approach includes 90-day cycles where managers attend workshops, practice learnings with their teams, then return for reflection. Crucially, teams provide feedback on whether their managers have “come back new.”
Singh claims this feedback-driven model shifts focus from performance correction to developmental growth. The programme sounds comprehensive, though its actual impact remains difficult to quantify beyond employee satisfaction surveys.
Listening architecture
CARE has built what Singh calls “multiple platforms for feedback”—confidential surveys, unit-level forums, and open mic sessions. The company runs monthly “listening” initiatives that collect thousands of employee comments, analysing themes at unit level.
This emphasis on employee voice reflects modern management thinking, though the cynic might wonder whether such forums genuinely influence decisions or merely provide the appearance of consultation. Singh maintains that leadership accessibility—including direct employee access to the managing director—demonstrates genuine commitment to transparency.
Results and reality check
The outcomes appear promising, according to the company. Attrition has declined over three years, and internal engagement scores have risen, with CARE claiming that 81 per cent of employees now describe it as an excellent workplace.
Yet challenges remain. Singh acknowledges that roughly 10 per cent of employees stay “on the fence,” requiring targeted engagement efforts. More broadly, CARE’s approach—whilst innovative—remains largely untested at scale. The company operates 17 hospitals; whether such intensive talent development could work for larger chains remains unclear.
The financial costs of this comprehensive development apparatus aren’t disclosed, raising questions about scalability and return on investment. Singh argues that business growth and reduced turnover justify the expense, though concrete figures aren’t provided.
The bigger picture
CARE’s experiment reflects broader challenges facing India’s healthcare sector. The country needs an estimated 600,000 additional doctors and two million nurses by 2030, according to government projections. Building leadership capability becomes even more critical when basic staffing remains problematic.
Whether CARE’s model offers a genuine solution or represents expensive over-engineering remains to be seen. The company’s focus on internal development certainly contrasts with the poaching wars common among Indian healthcare chains.
“CARE has been growing, CARE has been thriving,” Singh concludes, linking talent initiatives directly to business performance. The ultimate test, however, won’t be employee satisfaction surveys but whether CARE’s home-grown leaders can navigate the complex challenges facing Indian healthcare—from regulatory changes to increasing competition from both domestic and international players.
For now, CARE’s “farming” approach offers an intriguing alternative to traditional talent strategies. Whether it yields a sustainable harvest of healthcare leaders remains an open question, but one worth watching as India’s medical sector continues its rapid expansion.