Results of diagnostics tests dictate diagnosis and treatment. What is the level of treatment errors due to poor quality and varying proficiency levels in terms of healthcare outcomes?
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John Ledek
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With the diversity of quality levels among laboratories, not just in India but across the world, we see error rates ranging from near zero to 15-20 per cent. And sometimes that results in patients being called back so that the blood/ sample can be retaken for fresh tests. Other times, errors can lead to misdiagnosis where either the patient has the disease but its not diagnosed or in some cases, the patient is told he has a disease when he actually does not. Obviously that is tragic for the patient and the healthcare system. So, we look at what is the error level at a particular facility and how we can help them improve. If employees are constantly challenged to improve, it creates a culture for improvement. Hence, we think it’s important for all organisations to have a viewpoint on quality and how they seek to improve it.
How does the alliance between BD and CAP seek to redress this issue? How will this impact patient outcomes? Any data to back this?
Most often, it is the patient who bears the cost of low quality. Therefore, if we can eliminate this cost, then it lowers the cost of the healthcare delivery system as a whole. We believe that is going to be the case with all laboratories and hospitals as they improve quality. Patient outcomes have already improved in the 40 odd labs within India which are CAP-accredited. Errors also add to the cost, either to the patient or to the healthcare system.
And also misdiagnosis. Upwards of 70 per cent of all decisions are driven by the diagnosis results. If you have 1-15 per cent errors, then you have 70 per cent misdiagnosis rate. Eliminating those errors can help the healthcare system and save the patients considerable amount of money and time.
What is BD’s role in the roll out of this alliance?
Initially, BD will be managing the distribution of CAP’s proficiency testing tools and quality improvement tools. Right now, CAP’s challenge is to get these tools efficiently through each country’s customs to the customers. Hence, as soon as we become the channel of distribution, more labs will get access to these tools and this will lead to a better experience. It becomes easier to get access to them.
Secondly, many times when hospital labs use these tools, they have queries and need support, sometimes in the local language and in the same time zone. At BD, we can offer that customer support service, to answer all basic queries during the testing process. We expect that to be a big value driver in this relationship.
India already has some 40 CAP-accredited labs, mostly from the larger established players and diagnostic chains like SRL, Metropolis and Dr Lal Pathlabs. But not every player has the resources to be so advanced on this learning curve. So, how will this alliance benefit these smaller players specifically and the industry at large?
CAP accreditation is the gold standard when it comes to lab accreditation and everybody is not going to get to the gold standard in the first year. Therefore, part of our mission in this partnership is to define how we can develop those milestones from the very beginning and every step of the journey towards that gold standard. Many players may never get to that gold standard but that does not mean that they cannot improve quality.
So, whether we talk about other accreditation standards, ISO 15189 or just some of the audits we do, which we call ‘May I help you?’ where we come into a lab and make suggestions to improve the quality in the lab, all of these can help a lot of players. We do not see it as a ‘CAP or nothing’ situation; we feel everybody should be working on improvement of quality. It is a journey towards a quality goal where everybody could have a different goal. Some may want CAP accreditation while others may be fine with other accreditations. Others might want to solve specific problems with specific tests. So any where that customers have challenges, we want to be able to provide support. In a sense, such accreditations are an aspirational goal for players to live up to.
Since the BD-CAP alliance covers China and India, how do the two markets compare in terms of size, challenges, price points, growth potential, etc.?
Both are very large markets, with fast growth as more people get access to quality healthcare. As that access improves, so does the demand for quality. Both markets are very different in the way the healthcare systems are structured, the way care is delivered and who pays for the care. The priorities of the two governments are often different as well. But I think, fundamentally both governments seek to cover as many citizens as possibly. Hence, building the infrastructure to deliver this care is a very important priority for both governments. That is why the BD-CAP partnership aligns very well with those goals.
What will be the challenges to BD’s growth in India?
Looking ahead, the challenge is to expand into the tier II and tier III towns but we see every challenge as an opportunity. Specifically, the challenge about expansion into these tier II and III markets is how do you standardise quality of operations across players in such a fragmented market. As the bigger players consolidate, the challenge for the bigger player is to see that they lift up the standards of the smaller players and that is where we work very closely with the labs and hospitals to see that this happens.
Also, we are creating access to our products and services across tier II and III cities either through our education programmes or dispersion of our sales personnel in order to get closer to the customer (like smaller hospitals, nursing homes, clinics, etc) in these locations.
On the revenues front, where do the India operations fit into BD’s global revenues? And what are BD’s growth plans for India going forward?
We have been in India for over 17 years now and we are very proud of the success we have had over these years. We have tremendous talent here in India and we are very fortunate that many of our top performing employees in India have moved on to other locations across BD in other countries. So that is a clear message that if you do well here, we have opportunities all over the world.
India is an important market for us and a very important growth driver for our business. Our global revenues last year were $8 billion, 25 per cent of which came from emerging markets (China, India, Brazil, Latin America). Developed markets are growing in the two to three per cent range (US, Europe, Japan) while emerging markets are growing in the 12-14 per cent range. India grew at around 20 per cent over the past few years and we expect to maintain or even exceed this rate over the next few years, Nowhere else in the world, except China, do we see such growth. Partnerships like the one with CAP will help us grow.
Any specific strategies for growth?
As we grow our business further, one of the important things is that as more patients get access to care, there will be certain unique needs of the Indian market that we will want to serve better. For example, many of the top tier labs here are fully automated. That is the case in many of the developed markets of the world so products developed for automated labs are universal. But, many of the labs do not have full automation so what is the appropriate product for those labs? And they operate differently for instance, in rural areas, such labs have a lower volume/throughput of patients. Therefore there are opportunities to develop products unique to those labs that may not exist in developed markets. We do think that such products may be suitable for labs in other emerging markets which have similar set-ups in rural areas. Therefore, these are the areas that we are investing in to understand better and to see if we can come up with product solutions to address these challenges.
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