A Values-Based Approach To The Future Of Healthcare

That healthcare is in crisis is widely accepted around the world.  Costs are rising, providers are struggling to integrate new technologies and an ageing population is placing incredible strain on services.

Vijay Govindarajan and Ravi Ramamurti believe that the developing world holds the key to successfully overcoming these various challenges.  Their latest book, called Reverse Innovation In Healthcare, explores what healthcare providers in the west (although mainly in the United States) can learn from India in terms of delivering high-quality, low-cost care for all.

Reverse innovation in healthcare

Of course, the idea that India et al hold many insights in terms of innovation is not new, with the likes of CK Prahalad’s Fortune At The Bottom Of The Pyramid and Navi Radjou et als Jugaad Innovation, or indeed Govindarajan’s own notion of Reverse Innovation.

The examples of facilities such as the Aravind Eye Hospital and Narayana Health have propelled the likes of Devi Shetty to almost celebrity status.  Indeed, back in 2015 a delegation from the UK visited India to see what it could learn, with The Health Foundation producing a report from the visit.

As is so often the case however, progressing from knowing to doing is often the hardest thing.  Govindarajan identifies five key principles that he believes are key to transforming the innovations from India to the developed world.

  1. A driving purpose – all of the innovators identified in the book strive to deliver high-quality, ultra-affordable healthcare to all.
  2. A hub and spoke configuration – this is arguably the most interesting of the five and one I’ll focus on in a second post tomorrow.
  3. An enthusiastic use of technology – new health technologies are something I’ve written about extensively over the past few years, and they offer the prospect of a fundamental change in healthcare delivery.
  4. Task-shifting – which basically refers to use highly skilled staff only for work that requires those skills, and deploy lesser skilled people for more rudimentary work.
  5. A culture of cost consciousness – last, but not least, is a culture of conscious frugality, with waste removed wherever possible.

The authors argue that each of these principles is required for transformation to occur, and provides examples such as the University of Mississippi Medical Center (UMMC) and Iora Health to illustrate the potential gains that can be made.

Those gains are considerable, and there is much to admire in the philosophy advocated and the principles by which it can be achieved.  I do have a few caveats with it however.

Firstly, the book is unashamedly US centric.  Whilst that is not a bad thing in itself, a number of the ‘flaws’ identified in healthcare today are largely flaws that are confined to healthcare in the United States.

The nature of healthcare in the United States also lends itself to startups attempting to disrupt things in the ways outlined in the book.  How similar results can be achieved in less free market dominated systems is less clear from the book, and few of the examples have transformed existing organizations.

For instance, it’s been three years since the Health Foundation led the visit from UK healthcare leaders to India, and not much has really changed in those three years.  The act of change is unquestionably a difficult one, yet as with so many business books, it is made to seem quite straightforward if only you have the will and the energy to do so.

It’s undoubtedly an interesting book however, with some salient points, one of which I’ll return to tomorrow when exploring the hub-and-spoke configuration principle in more detail.

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