Innovating for good health

Dr V K Singh

Innovation is a process of translating an idea into goods or service that create value for which the customer is ready to pay. Idea is to be replicable and the economic cost must satisfy a specific need. Innovation involves deliberate application of information, imagination and initiative in deriving greater or different values from resources, and includes all processes by which new ideas are generated and converted into useful products. Innovations have two broad categories: (1) evolutionary innovations (continuous or dynamic evolutionary innovation) that are brought about by many incremental advances in technology or processes and (2) revolutionary innovations (also called discontinuous innovations) which are often disruptive and new. Innovation is synonymous with risk-taking and organisations that create revolutionary products or technologies take on the greatest risks because they create new markets or models for implementation.

Innovation in manufacturing is known to exist since decades. However, its entry into the healthcare delivery system is of recent origin, after technology has crept into the health domain to assist qualitative outcome and effect reduction of cost. Innovation could be considered at three levels, firstly, at process improvement level to remove waste, reduce cost and improve outcomes. Known as lean theory of quality, many such improvements made in process and behaviour modification or cultural changes impacting organisation is called transformation. Arvind Eye Hospital is an example of improving process to reduce cost and waiting time considerably for patients. Second level is to take the help of technology in improving processes, this can be seen in clinical or non-clinical areas of hospital departments or public health institutions in the form of hospital information system (HIS), telemedicine, e-health, barcoding, radio frequency identification device (RFID), electronic health records and use of various other devices. Third level is product or technology development for improvement of process like developing smart phone application for use by Accredited Social Health Activist (ASHA) worker, getting a ECG tracing of a patient through mobile telephone for assessment at hospital, development of Information & Communication Technology (ICT) and mHealth to aid operation is product innovation.

Environmental and operational dimension of healthcare innovation

Concepts like lean transformation and innovation overlap, but these are two sides of same coin. A book titled ‘Jugaad’ compiles few such innovations in India in various sectors impacting social outcomes. ‘Jugaad’ is a colloquial term for innovation in India.

CK Prahalad, in an article published in 2006 stated,“to create an impossibly low-cost, high-quality new business model, start by cultivating constraints. Once the “sandbox” of constraints is defined, unconventional thinking can occur in many directions at once. The result is often breakthrough innovation that doesn’t just change processes; it changes lives.

India’s healthcare system is on a similar trajectory, with innovation coming from a national objective of providing poor people the same world-class healthcare as the rich. The author describes a set of self-imposed constraints, which can vary by industry and are derived from previously ignored consumer insights. For India’s healthcare industry, the sandbox is constrained by four sides:

• Innovation must produce products or services of world-class quality;
• It must achieve a significant price reduction of at least 90 per cent;
• It must be scalable to serve both rural and urban environments; and
• It must be affordable by all, regardless of income.

That sounds like a good model for a healthcare system, so there are many lessons we can learn from innovation in India and the sandbox model.

Health innovation is having two components, environmental and operational dimensions, contents of each is explained in the adjacent figure.

In India we handle volume in healthcare as too many patients are consuming limited resources available. However we continuously innovate in process improvement. Some of the innovations adopted by organisations that have positively impacted the Indian healthcare system are as follows :-

• Arvind Eye Hospital is one example as it is the world’s largest provider of cataract surgery, performing 240,000 procedures per year with no waiting and providing qualitative care at 20 per cent cost.
• Life Spring Hospitals is the another good example of providing quality of healthcare at affordable cost by innovation where deliveries are conducted for Rs 4000 and caesarean section for Rs 9000.
• Narayana Hrudayalaya is one of the world’s largest providers of cardiac care and heart surgery, performing dozens of surgeries per day. It’s a very efficient system that charges a fixed rate of just $1,500, about seven per cent of what a typical US hospital might charge.
• Jamkhed rural healthcare providers is another example of how a community can be provided with preventive, promotive, curative and rehabilitative services under one roof at affordable costs
• Chiranjivi project has innovated in Gujarat for safe deliveries in best hospitals at minimum cost to reduce infant and maternity mortality rate. It was a great success and is replicated in other places.
• Jaipur Foot is a prosthetic foot made of rubber for below-the-knee amputees. Such a prosthetic in the US would cost $8,000-$10,000, it costs just $30 in India. The foot and other prosthetics are distributed and fitted for free by nonprofit organisations.

Healthcare needs more innovation in process to reduce cost, increase efficiency and remove waste rather than product development. There is 90 per cent waste in the health sector and it is mostly in processes. Process innovation adoption can be seen in hospitals enumerated in the preceding paragraph.

Innovation has to be market driven and a quest for new technology to improve operation, transparency, accountability and reduction of waste would ultimately benefit healthcare providers and patients by reducing cost. Innovation is of four types e.g. product innovation, process innovation, marketing innovation and organisational innovation. Technology is used for streamlining process and development of new technology is based on healthcare providers and patients need. Innovation in healthcare is ultimately in product, process and structure.

National Innovation Council has been created by the Government and funding is provided to incubate newer ideas and innovation. It would bring out talents for the benefit of society. Innovating in the health sector would impact India by providing qualitative healthcare delivery system for masses at affordable cost. There is a need to use common sense which can be translated in scientific concepts like ‘dabbawala’ (tiffin delivery service of Mumbai) got six sigma rating unknowingly. There are innumerable examples in India to show healthcare providers, entrepreneurs and planners that innovation is the key for qualitative healthcare at affordable cost and breakthroughs occur when clusters of innovation overlap, taking place through small experiments over time.