01 Jun 2018
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Disrupting India’s Dental Market

How consistency fueled an upstart chain’s rapid expansion
by Sasha Issenberg

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Photo by Vivek Singh/The Verbatim Agency

Amar Singh (MBA 1998) traces his curiosity about the Indian dental marketplace to the type of experience that might scare most people away for good. Lured in by the $20 price—roughly equal to Singh’s insurance copay when he lived in San Francisco—he visited a clinic in his Delhi neighborhood in late 2010. He was satisfied with the quality of his care until, hovering above the spittoon, he spotted black fungal algae encircling the drain. Something about the entire business struck Singh, an entrepreneur with experience in supply-chain management, as disjointed. “Here’s a Western-trained dentist,” he recalls thinking, “but the process is not working.”

Singh, who spent his formative years in Canada and his adulthood in the United States, had recently moved back to his native India so that his children could be raised among family. Now 48, he had not lived in the country since he was 12, and slotting into a job in an established business had little allure. He wanted to start something new, ideally a for-profit enterprise that would have a visible social impact. But when he thought about health care delivery, Singh found himself daunted by the barriers to entry that would accompany opening a hospital. “I didn’t want to get into real estate,” he says. “I wanted to get into a service business.” Perhaps even more appealingly, dentistry did not depend on referrals from other doctors, which turned Indian medicine into “a B2B business, rather than B2C,” in Singh’s words, warping incentives for better care along the way. “If one person is looking for a cardiologist, the question is always, ‘Who is the best cardiologist?’” he says. “When it comes to a dentist, the question is, ‘Who is convenient? Who is good?’ It was a business where a brand could be built without sacrificing my ethical standards.”

Indian dental clinics, where size is measured in the unit of chairs, had much smaller overhead, with a specialist’s time by far the most expensive element. For that reason—perhaps along with advertising restrictions enforced by the Dental Council of India—few had ever looked for economies of scale or scope. Dental practices were typically a single office run by the same person who wielded the mirror and probe. Chains usually topped out around a dozen locations, which Singh concluded was the most a medical practitioner could oversee without bringing in professional management. “Entering an industry that was entirely mom-and-pop,” he says, “we found the auxiliary services around it were also non-organized.”

Singh saw an opportunity to create a national chain that would offer a consistent patient experience while remaining sensitive to cultural differences across the polyglot country. He raised $1 million, primarily from American investors he knew personally. In March 2011, he opened a small clinic (two chairs) in Delhi to serve as a pilot project. He set out to vertically integrate all aspects of the business, from recruiting and training to design and construction. Singh’s team reduced a clinic to a set of eight distinct modules, such as the operating rooms and waiting areas, that could fit together “like a jigsaw puzzle” in any new space.

“It was a business where a brand could be built without sacrificing my ethical standards.”

“It was a business where a brand could be built without sacrificing my ethical standards.”

Assembling a workforce was more of a challenge. Indian dental colleges were producing plenty of polished graduates, but there was little training for hygienists or other support staff. Singh decided to have dental professionals answer the doorbell at his clinics, instead of dedicated front-desk staff. “You will get a dentist who will begin a relationship with you when you walk in,” says Singh. From that point, the dentist becomes personally responsible for every patient interaction, from scheduling appointments to processing payments. “That’s when they have a real conversation with the patient,” says Singh—offering a better opportunity for bonding than when the dentist is hovering over a patient during an exam.

In 2012, after raising another $8 million from investors, Singh opened three more locations (including a mobile clinic) with the new brand Clove Dental. The nascent chain took its name from a spice whose analgesic properties have made it a traditional Indian folk remedy for a toothache. The growth plan relied on clustering, requiring at least 15 locations within a drivable range, because instead of sending patients to a periodontist or prosthodontist, Clove brings the specialist to the patients. And while the dominant language in Clove clinics nationwide remains English, in which Indian dentists are trained, signage varies based on the dominant local language, often spoken by dentists hired to work within their own communities. “The good news is the dental processes are uniform,” says Singh.

After taking five years to reach 100 locations, Clove grew at an exponential rate, nearly doubling its number in 2017 alone. Today, it has 217 clinics, clustered in four major metropolitan areas, and 580 staff dentists. (Just under half of the clinics are in Delhi and its surroundings.) Singh plans to open 600 clinics by 2020, and then develop a strategy for another stage of rapid growth. “I have to show a path from 600 to 6,000 if I am to permit an exit to my shareholders,” he says. Those expansion plans are all confined to India, although some of the auxiliary services Clove has developed could be marketed beyond. For example, Singh created an online marketplace for dental instruments and equipment, called OneIvory, as a supplier to independent clinics, and he has begun to license his “dental quality management” system to other chains. About one-third of Clove’s procedures are audited by colleagues who examine anonymized X-rays as a form of what Singh calls peer review, a process that he says can be useful anywhere. “It becomes a training tool at the same time it’s a quality-control tool,” he says. “Dentists love to critique other dentists’ work, so they enjoy doing it.”

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Class of MBA 1998, Section H

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