Madan Krishnan, Vice President, India Medtronic
Why is it important to plan a proper growth strategy for a company?
We believe medical technology has a key role to play in delivering better patient outcomes while improving efficiency for healthcare systems. However, around the world and in India, healthcare systems are marred by rising costs, ageing population, burden of chronic disease and the barriers of accessibility, affordability and awareness. In such a scenario, having a robust strategy that not only addresses the barriers but creates leapfrogging opportunities, becomes critical for the organisation to advance from its current situation to its desired situation. Also, changing customer behaviours, policy changes, price control and other regulatory changes are forcing companies to evolve newer business models and rethink existing models of operation.
At Medtronic, our performance continues to be driven by our growth strategies of therapy innovation, globalisation, and economic value. To do our part, we need to adapt our company and offerings, commit to continuous innovation to stay ahead of our competition, inventing new therapies and markets, and disrupting existing markets. We also need to aggressively develop other unique, value-based innovations to achieve more integrated and efficient care.
What are the core values that initiate growth for the company?
“To strive without reserve for the greatest possible reliability and quality in our products; to be the unsurpassed standard of comparison and to be recognised as a company of dedication, honesty, integrity, and service”- Tenet 3 of Medtronic’s mission defines our core values. Written in 1960, our mission dictates that our first and foremost priority is to contribute to human welfare. Over a half-century later, the mission continues to serve as our ethical framework and inspirational goal for our employees. It guides our day-to-day work and reminds us that our efforts are transforming the lives of millions of people each year. If a company takes the time to be clear about its core values, making strategic decisions about growth can be much clearer. It can also be of significant value in terms of deciding what not to do, which in some cases is just as important as deciding what to do.
How does Medtronic look at growth in India?
The Indian healthcare sector is evolving rapidly and is expected to be $280 billion in size by 2020. Growing health awareness and changing attitude towards preventive healthcare is expected to boost healthcare services demand in future. The growth opportunity for Medtronic in India is vast, but to seize it, we must focus clearly on making our innovative devices accessible to a larger section of Indian society. To do this, we are partnering with stakeholders across the healthcare ecosystem as well as outside the sector as well, to reduce or remove the key barriers to healthcare, improve outcomes, reduce total costs of care and improve healthcare practitioner skills. Medtronic continuously works towards driving Meaningful Innovation i.e. Product Innovation – Bringing iterative innovations in the market, procedure innovation – Developing newer methods of surgically or with minimally invasive approach, delivering technology to patients and Health System Innovation – Working on the 3A’s of healthcare i.e. Awareness, Access and Affordability.
Tell us about the company’s major achievements, measurable results in the last 3-5 years.
Medtronic began its operations in India in 1979. The journey has been both gratifying and riddled with learnings for us in terms of understanding the market, needs of patients and filling the gaps in the care pathway. We’ve developed some meaningful innovations tailor made for Indian patients that have added real value in improving patient outcomes. I’d like to share some examples of our innovation and skill building efforts in India.
Health system innovation
- Shruti: Medtronic launched ‘Shruti’ in July 2013 with a philosophy to create sustainable programme of low-cost otology care including awareness, screening, diagnosis, and low-cost treatment to the underserved, particularly in densely populated, low-income urban settlements and rural areas by leveraging medical technology, telecommunication, and frugal innovation. With an ENT doctor as the central point of care, the programme is operationalised through trained community health workers (CHW), working for the ENT doctor and equipped with an ‘Ear Screening Kit.’ Patients with a positive provisional diagnosis are routed to the doctor for receiving low-cost treatment, including advanced diagnosis, medicines, audiometric tests, surgical interventions and hearing aids. It is a hallmark example of Business Model Innovation, serving dual objects of social impact and business viability simultaneously.
In December 2017, a case study on the patient impact of the Shruti programme was published by BCtA (Business Call to Action) – a United Nations Development Program (UNDP) initiative.
Shruti is currently operational in 25 hospitals/ clinics across country and has reached out to more than 390,000 people in India. Approximately 8,000 people have received life-improving treatment at a significantly reduced cost through the Shruti programme.
- Saartham: Trauma patients in India face numerous challenges in accessing quality care which impact recovery time, outcomes, and quality of life. There is a need to improve patient follow-up, training and education of trauma specialists and the affordability of care. Saartham was an initiative launched by Medtronic in partnership with a hospital in Amritsar to provide integrated care for orthopaedic trauma patients tailored to their individual needs, including counselling and patient management.
Product and procedure innovation
Medtronic has been leveraging the unique strength of India beyond providing therapies to the patients in India. To take advantage of India’s strength with a large pool of qualified engineers, doctors with a wide ranging patient pool experience and hospitals providing quality care, Medtronic established two Research & Development (R&D) centres, in Bengaluru and Hyderabad respectively. The Medtronic India Development Centre in Bengaluru develops the key aspects of Medtronic’s renal care solutions business. Medtronic Engineering and Innovation Centre in Hyderabad provides advanced engineering R&D support to the Global Business Units in the areas of design, analysis, hardware, software development and testing, while developing a footprint for future product development for the region and country.
Skill building
India Medtronic also has a therapy and procedure training centre in Dhaka, Bangladesh and a Medtronic Innovation Centre in Mumbai. These centres conduct a wide range of clinical education and training programmes for healthcare professionals to address capacity and awareness barriers and increase patient access to various therapies. For training and education on Medtronic products and therapies, customised curriculum is developed to address the educational needs of interventional cardiologists, radiologists, vascular, general surgeons, gynaecologists, oncologists, spine surgeons, MD physicians, diabetologists, and endocrinologists, nurses and technicians. Programmes are also designed for non-clinical stakeholders. Another initiative in improving physician education and training them on our therapies is the platform MedEX. We have created a web-based electronic portal that offers the flexibility of being accessible to all cardiac experts at anytime from anywhere and from any device. It enables interventional cardiologists with knowledge, skill set and guidance to perform complex interventions. The treating cardiologist uploads the patient details including the angiogram report on the portal and other complex case details and queries. Intimation is triggered to one of the members of the panel of experts who have registered themselves on MEDEX portal. These experts can be from different parts of India. On the portal, experts reviews the case and provides a structured report alongwith their recommendations and answers within 48 hours.
Global IT Center – Established in 2014, the centre in Bengaluru is part of the company’s global strategy that will directly contribute to the IT goals of optimising costs, enabling growth and providing operational excellence to all its stakeholders through a culture of innovation.
What strategies have been adopted by the company that makes it stand out?
Medtronic products are different from its competitors in terms of the breadth and depth of clinical evidence it generates through various clinical trials and registries to establish the safety and efficacy of its product. The depth of our commitment and the breadth of resources uniquely position us to help solve the greatest health challenges of our time. To do our part, we need to adapt our company and offerings to achieve more integrated and efficient care. Our business strategy helps us do just that, built on three key elements:
- Therapy innovation: Providing a spectrum of offerings aimed at improving both economic and patient outcomes.
- Globalisation: Adapting our thinking to address access challenges in both developed and developing countries.
- Economic value: Thinking more holistically about the care continuum, and how we can lead the creation of value-based healthcare solutions.
Give us five areas that the company has focussed to achieve its goals in India?
We have been present in the India market for 39 years. With our immense experience and understanding of the market, we have focussed our approach towards the following key areas –
- Increasing patient awareness – Through our direct to patient engagement efforts in the media and our marketing efforts at caregiver and patient levels, we’ve been consistently involved in improving patient awareness for most of our therapies.
- Improving physician education and devising custom training programmes – TPTC and MIC information shared earlier.
- Tailor-made solutions for Indian patients – Shruti and Saartham examples shared earlier.
Talent management – The medical devices sector is undergoing a major transformation, both in terms of changing customer profile and evolving new business models. For a complex and under-resourced market like India, it’s important to build capabilities that drive innovation and value creation in all the aspects of a company’s operations for a successful resolution of the the barriers around healthcare. Our experience of taking a sector agnostic approach has helped. Our expertise lies in identifying people who can apply learnings through experiences and skill-sets to our new situations successfully. For example, we hired a few middle management talent from industrial and FMCG sectors for our distributor management and sales operations roles. They brought in unique capabilities in this area by driving stronger systems and processes. Apart from this, Medtronic is also focussed on gender diversity and we have various programmes to encourage and develop female talent and groom them to take up leadership positions in the organisation. A lot of emphasis is laid on career development programmes.
Innovation is a big differentiator in most cases. Tell us how much Medtronic invests in innovation in terms of funds, employees and research?
Meaningful innovation in medical technology improves peoples’ lives and brings the benefits of treatment to individuals whose conditions may previously have been difficult or impossible to treat. Meaningful innovation can come in many forms like a new feature to make a product more useful or a unique way to apply an evolving technology to a real-world problem. As a global leader in medical technology, Medtronic aspires to drive progress in innovation and devise powerful solutions with proven clinical and economic value as the basis of our offerings and value proposition. For us, our customers and patients remain at the centre of our relentless pursuit to transform healthcare.
Whether it’s our innovative models like Shruti and Healthy Heart for All or the R&D facilities, Medtronic already has a track record of investment in addressing the barriers to healthcare and new technology development in India, that are being designed for use within the country and worldwide. Medtronic may be prepared to do more in research and manufacturing in India if we can achieve patient volumes to support such investment.
Globally, Medtronic has 50 research and innovation centres and made an investment of $2.2 billion in R&D as of FY17.
Which innovations have been more profitable and successful for the company?
- Transcatheter Aortic Valve Replacement – There are approximately 14.5 lakh patients who suffer with severe aortic stenosis in India, of this, 30-40 per cent or 4.5 lakh patients are deemed unsuitable for open heart surgery due to age and other conditions. TAVR is an example of meaningful innovation from Medtronic where the procedure technique has been innovated and the product also has gone through a transformative change to create better patient outcomes. Traditionally, aortic valve replacement was done by surgically removing the diseased valve. In surgical aortic valve replacement (SAVR) the chest is opened which provides the surgeon with necessary access to the heart and chest cavity, in order to replace the aortic valve. The valve gets replaced during 2-4 hour procedure (typical) and requires typically 12 day hospital stay. In TAVR, doctors replace diseased aortic valves by implanting artificial heart valves through femoral artery route (through the leg). It requires a minimally invasive approach without an open heart surgery. Further, innovation in TAVR has made these valves recapturable so that physicians can make sure the device is implanted in exactly the right spot. TAVR is recommended for patients who are inoperable or at high risk for open heart surgery. Post TAVR procedure, patients typically can be up and walking within 24-48 hours after their procedure and the typical hospital stay is approximately five to six days.
- Deep Brain Stimulation Therapy – Parkinson’s disease is a progressive, degenerative neurological movement disorder. It is considerably more common in people over 60. As Parkinson’s disease progresses, it becomes increasingly disabling, making daily activities like bathing or dressing difficult or impossible. Medtronic believes in meaningful innovations that result in powerful and positive patient outcomes led to the invention of Deep Brain Stimulation Therapy (DBS). DBS helps control movement symptoms when medications aren’t working as well as they used to. For many people with Parkinson’s, DBS makes a difference when even small tasks have become challenging. DBS has helped some people stay as independent as possible and keep doing the activities they love.
- Insulin pump therapy – Typically diagnosed in childhood, people with type 1 diabetes have a pancreas that is unable to produce insulin, a hormone that regulates blood sugar, or glucose. Unfortunately, there is no cure for type 1 diabetes, so treatment aims to keep blood glucose levels as normal as possible to minimise the risk of developing complications. An insulin pump is a small device (about the size of a cell phone) worn externally that delivers insulin through a tiny plastic tube inserted underneath the skin. Medtronic devised an insulin pump with built-in Continuous Glucose Monitoring (CGM) that both automatically suspends insulin delivery when sensor glucose levels are predicted to approach a low limit and resumes insulin delivery once sensor glucose levels recover.
Going forward what are the growth plans of Medtronic?
Medical technology has revolutionised the way healthcare is delivered worldwide. As India is on its way to become a global super power, the government is now focussing on providing affordable and quality healthcare for all. More patients can benefit from the innovative technologies only if the barriers like awareness, access and affordability are addressed together. However, no one entity can address the challenges of healthcare of this magnitude alone. In a diverse country like India where healthcare is complex, we need collaboration from all the stakeholders, across levels. India has been emerging as a country where companies combine the advantages of local production and India’s talent pool to help drive innovations in product technology, service delivery and operating models. A combination of western technology with Indian knowledge and skills in engineering can help bring down cost and drive innovation in affordable healthcare. We are partnering with various stakeholders in new and different ways and expanding our expertise. We not just believe in creating innovative devices and therapies, but in employing all our skills and assets to help drive more value into healthcare.