Following the bloodline to business success

Akshat Garg is shaking up healthcare in India. In 2009, together with his brother Aseem, he co founded DCDC Kidney Care, which stands for Deep Chand Dialysis Centre. Lt Deep Chand Garg was their inspirational, deeply charitable grandfather. DCDC Kidney Care is the first of its kind: a healthcare facility specialising in providing quality dialysis care to patients suffering from end-stage renal disease.

What makes it special is that the service encompasses the physiological, financial and psychological aspects of dialysis treatment, as well as the physical. In the past, Garg explains, patients with kidney failure had to attend hospital three times a week to undergo a four-hour blood purification process. It was time consuming to get to the hospital, he says, and patients often turned up in wheelchairs, supported by their families, feeling that they didn’t have much quality of life. 

“The delivery of dialysis in India was in a sorry state when we first encountered it,” Garg says. DCDC Kidney Care wanted to change the script. “We said that people needed to be treated in a dignified manner and encouraged to lead meaningful, active and productive lives.” The model was to set up dialysis centres in convenient locations, so that patients could access them more easily. This enabled many patients to continue working, to remain independent and have as much of a normal life as possible. It was quite the transformation of an outdated model. 

“I’m not knocking the way it was done before,” Garg says. “But there wasn’t much incentive to improve things,” he adds. In the system of a big hospital, he explains, dialysis brings in only 2-5% of the total revenue. “As a hospital manager, the logic is to focus on conditions such as heart disease or transplants, which bring in 70% of my revenue.” Garg says that by contrast, 100% of his revenue comes from dialysis, so he can give it 100% of his energy.

Garg co-founded DCDC Kidney Care 12 years ago, at a time when, he admits, he had “no experience in healthcare”. He came from a business-minded family, and there was the expectation that he would follow into the family business, in steel and ball-bearings. 

But Garg knew he wanted to create a legacy of his own. After completing a Bachelor of Sciences in 2007, Garg began his career as a financial analyst. After two years in the financial industry, he was poised to start an MBA from one of India’s leading institutions, when he saw the opportunity in dialysis provision. He dropped out of the MBA program to launch DCDC Kidney Care, where he is now director and manages day-to-day operations.

“In order to do that, I had to fund the new venture from my own funds and get a bank loan. I organised corporate events and arranged professional speakers, such as the American marketing consultant Philip Kotler, to attend, and managed to further generate funds that way.”

Garg admits that, as a young graduate, he jumped into the business side of things. “I started with some crazy ideas, without any experience to speak of,” he says. But he knew he’d never be as passionate about a business that somebody else started. “It’s all about the drive of setting it up yourself. You have to care about it. I wanted something of my own,” he says.

The business opportunity for a dialysis centre chain was very encouraging, but Garg had to convince his family about its merits. His parents warned him that healthcare shouldn’t be for profit. “They wanted to know how I could make money out of someone’s suffering. They were supportive, but only if I was doing it for charitable reasons. If not, they encouraged me to do something else.” But, Garg says, he came from a different school of thought. “I felt that whilst charitable organisations were well and good, some of them, after a period, failed to serve their purpose anymore.”

DCDC Kidney Care was Garg’s first professional experience as a young graduate. Whatever he has learnt about business acumen, the structure of a company, he has learnt on the job. Of course, the demands of a fast-growing start-up are challenging financially, but also personally. The company had to make things work on a strict budget and his work-life balance suffered, Garg says.

“At times, it has been lonely,” he says. “In a corporate setting, you have processes built in and hierarchy you can learn from or fall back on. But I didn’t have time to have second thoughts. I could talk to my peers or team members, but at the end of the day, I was calling the shots.” 

Being a person from a non-medical background, Garg faced a lot of rejection by industry and medical professionals. Even when others in the industry were telling him he was “playing a fool’s game” and he “didn’t know what he was doing”, Garg took no notice and continued on his path. “It was disheartening at first, but we wanted to prove people wrong.” Garg was fortunate enough to partner with like-minded medical professionals, whose expertise he respected and, in turn, they respected his management skills. “We became a potent team,” he says.

The most rewarding aspect is seeing how people receiving dialysis care have transformed under the DCDC model. “When we launched our first centre, 70-80% of our patients would arrive with oxygen masks on, in wheelchairs, with family support.” It was disheartening, Garg admits. “All these naysayers were saying, ‘Why are you going into the medical world?’ We thought, are we really going to do something for the rest of our lives that is so grim?” 

But very quickly, the team at DCDC Kidney Care gave the patients proper care they needed. Before long, their appetite started increasing and they felt good about themselves, empowered. We asked them to start working, and that was a big psychological aspect for these patients. They have been made to feel that they had no purpose. In less than a year, nobody any more arrived in a wheelchair. That gave us such a boost,” Garg says.

DCDC Kidney Care also encourages its patients to return to work, by offering discounts on services to those that can present proof of work. “This helps and encourages patients to work for themselves,” says Garg. “Which further helps their psychological aspects. Patients who work, feel empowered and have a sense of purpose, which also translates to better health and clinical results.”

Today, DCDC Kidney Care has emerged as the second-largest dialysis centre in India, providing affordable quality dialysis to over 7,500 patients on a regular basis, including many in marginalised areas. “We now have over 125 centres spread across 10 states and 80 cities in India, which puts us among the top five dialysis providers in Asia and the top 15 in the world.”

All the hard work paid off. Garg, 35, recently became the later-stage winner of London Business School’s Accomplished Entrepreneur Awards – a prestigious prize that recognises alumni who revolutionise their industry. “It was a surreal experience,” he says. “Any kind of recognition is heart-warming but coming from a community like LBS was another level. LBS is full of over-achievers, the best of the best. To win that award was very special.” 

LBS really changed things for Garg, he says. “I’d been running DCDC Kidney Care for a decade and the focus during that time had not been on my personal development.” He knew things had to change, so applied for the LBS Sloan Masters in Leadership and Strategy, class of 2019. “It was an incredible environment for me, and I gained a great deal from investing in myself in this way.”

Has the pandemic further changed healthcare in India? “Absolutely,” Garg says. “Things got chaotic, with social distancing. Our costs went up, which put pressure on our balance sheet.” But people who wanted to limit touch points, chose not to go to hospital and try DCDC Kidney Care instead, opting for home dialysis, which is new, he explains. “Twice a week our medical professionals go to a patient’s home, and that has really taken off during Covid.” 

As for the future, Garg says that he would like to have a global impact. “My journey has been largely India-centric. Now we’re already thinking about international expansion. We aim to be a 500-centre-strong South-East Asian dialysis provider in the next five years.”

It’s easy to see his grandfather’s influence. Lt Deep Chand Garg arrived in Delhi from rural India 70 years ago and dedicated his life to helping people from his home village of Karora relocate 150km south to Delhi in the hope that they, too, could have better, more secure lives. “He identified a better and progressive life in the capital,” says Garg. Lt Deep Chand Garg sponsored even people who couldn’t buy homes or land of their own, telling them that they could pay back the money “whenever they could afford it”. 

He helped to build several key buildings in his area, the Punjabi Bagh area of New Delhi – a temple, a community centre, a charitable school and hospital, which, incidentally, is still one of Delhi’s biggest private hospitals. “My grandfather got the community together. He fronted money for charitable causes and encouraged others to do so, too.”

Now, considering the question of charity versus profit, Garg says it’s possible to achieve both. DCDC Kidney Care also operates its ManoDeep Charitable trust, which raises funds through CSR and other avenues. “The trust supports 200 patients who receive free dialysis services in our centres,” explains Garg. “DCDC Kidney Care is a for-profit company, but we are also able to change people’s lives for the better, and this gives us a lot of encouragement – to have someone walk up to you and say that you have changed my life.” And, like his grandfather before him, respect is paramount. “We feel part of the community,” Garg says. “We get invited to a lot of people’s children’s weddings. We call it our DCDC family.”