How The Hub And Spoke Configuration Could Transform Healthcare

Yesterday I explored the latest book by Vijay Govindarajan, which proposes a number of ways in which healthcare in India can boost healthcare in the developed world.

The book outlines five key principles by which the authors believe the west can learn from healthcare pioneers in India.  One of these is the so called hub-and-spoke configuration, which basically advocates allocating only the toughest cases to the highest skilled employees.

So the hub would be retained for the most challenging cases, with each rung outwards attempting to intervene at a much earlier stage where the skills required of staff are lower.  The authors suggest this has a number of benefits:

  1. It concentrates the use of expensive equipment – the argument is that there is a lot of duplication and wastage throughout modern health systems, with expensive equipment laying un-used for large periods of time.  The aim is to ‘sweat’ the expensive stuff as much as possible.
  2. It centralizes scarce expertise – few countries have an abundance of medical expertise, so it makes sense to make the best use of what you do have.  This means freeing expensive experts from mundane tasks that they don’t need to do, whether that’s administration or routine tasks that can be performed by other staff.
  3. It turns each hub and spoke into focused factories – rather than facilities trying to be all things to all people, a hub-and-spoke model encourages them to focus and specialize instead.  The Aravind Eye Hospital is a well known example of such specialization, and they churn out top-notch eye surgeries at a rate and expense that is the envy of the world.
  4. It accelerates learning and development – this specialization and volume of work then supports the development of skills in those facilities.  They truly become masters of their domain.
  5. It facilitates system-wide protocols – a central tenet of lean systems is that they have strict ways of working that are optimized for peak performance.  This sounds a bit like a recipe for intransigence, but the authors argue that it also allows for procedures to be performed by lower-skilled personnel.

The book doesn’t focus too much on technology, but the general push of more routine procedures down the value chain inevitably leads to each of us taking more control over our own healthcare.

Technology can play a crucial role in that.  Whilst the book does talk extensively about telehealth allowing more extensive services to be delivered within communities, the development of AI technologies opens up the prospect of much of our health and wellbeing being monitored remotely, with algorithms monitoring the data that we generate about our health for signs of abnormalities.

The authors talk about a new ‘health coach’ role that is crucial to this transformation.  These people are generally less educated than traditional healthcare workers and operate purely in communities.  They exist to help us to stay healthy for longer, keeping in close touch with the people under their remit, monitoring their health and advising them on areas such as lifestyle and diet.  These health coaches are assigned to everyone, not just people that are sick and form the anchor around which all other services revolve.

Of course, technology could play this role too, and indeed I’ve written about a number of services that attempt to do this, but Govindarajan advocates this being a human being, albeit one that’s supported by technology, both in terms of generating health data but also analyzing it.

It’s an approach that has been adopted with considerable success by Iora Health, whose service revolves around the health coaches that aim to keep people healthy rather than purely fixing them when they’re sick.  Their approach has resulted in considerably fewer (expensive) visits to hospitals, and a much healthier community as a whole.

Suffice to say, Iora Health are a startup and so had the benefit of beginning with a blank sheet of paper rather than transforming a legacy business with a lot of vested interests.  Whether such a transformation could be achieved in something like the National Health Service is much harder to envision.