Eleni Vlachos

Process, Not Product: How lessons from India can transform health care across borders

Have you ever had a meeting that ended with one of the participants rushing off to perform open-heart surgery? Me neither.

So I was surprised to learn that my boss Richard Bartlett, associate director of the International Partnership for Innovative Healthcare Delivery (IPIHD), rushed out of his meeting at Narayana Health, quickly changed from business tie and cufflinks to blue scrubs, and sprinted to the operating room to observe his first open-heart surgery – performed by the senior surgeon he had just been meeting with moments earlier.

Narayana Health wastes no time or resources. Right-skilling the workforce (matching jobs with a level of training, instead of hiring over-skilled workers), making good use of the cardiac surgeons’ time, promoting efficiency through sleek and slim operations – these are all areas that have been consistently improved and refined until the resulting operation for the patient is affordable, quick and, perhaps most importantly, of high quality.

Narayana, like other leading health care innovators, helped break down the barriers preventing quality care. Fortunately, many other innovative health care models exist, particularly in India. The initial research that led to the founding of IPIHD uncovered many examples of innovation around the world that increased access, affordability and quality of health care delivery.

IPIHD was founded by the World Economic Forum, McKinsey & Co. and Duke Medicine to increase access to health care worldwide by identifying promising health care innovations and helping expand their sustainable and successful operations in partnership with corporate and foundation supporters.

One of the key areas of interest for IPIHD is how we can apply lessons from these innovative models across borders.

As Bartlett’s eye-witness experience to heart surgery attests, reading facts about innovations is no substitute for seeing them in action. Over the course of two years, IPIHD and our supporters have made several in-person visits to IPIHD innovators in Africa, Latin America and India. Inspired by these visits, IPIHD corporate and foundation supporters have facilitated the growth of innovation in many ways, including establishing a foundation for innovators, funding their expansion and sharing business expertise worth $10,000 per innovator per year.

LV Prasad Eye Institute (left) provides about half of its care for free.

Realizing the power of in-person visits, IPIHD is launching a study tour series to inspire health systems leaders to learn from global innovations and apply these lessons and principles to their own systems. Each tour is a private, invite-only package for IPIHD supporters and guests. The inaugural study tour is in India, Oct. 6-10, diving deeply into the operations of four IPIHD Network innovators: Narayana Health, Vaatsalya Healthcare, LV Prasad Eye Institute and LifeSpring Hospitals.

One of the attendees, Dr. Victor Dzau, is also president and CEO of the Duke University Health System, and has a vested interest in innovation as both a founder of and the chair of IPIHD.

Speaking about why he is participating on the study tour, Dzau said, “I am excited to learn, through IPIHD’s knowledge program, about innovations in care delivery from developing countries and also to share these successes for ‘reverse innovation’ with health care leaders in developed countries.”

Other health system leaders participating include Rosamond Roughton, the interim national director of commissioning development at the National Health Service in England. “I’m most interested to gain in-depth exposure to innovative models of care and principles driving their success as well as discussions on how to translate these models of care to the developed world – specifically, the U.K.,” she said.

Dr. Molly Coye, the chief innovation officer at the University of California, Los Angeles, is also joining the tour and excited about the implications for translating the innovations to the U.S. “The UCLA Global Lab for Innovation is focused on reverse innovation – and frugal innovation – in order to identify innovations that can meet patient needs with far less resources than developed economies currently require,” she said. “IPIHD provides a key opportunity for us to collaborate with innovators in every region in search of these advances, particularly through their upcoming India study tour.”

Attendees will learn about each of the four organizations through full-day visits which will include in-depth presentations by the organization’s senior leadership, deep-dive tours of care delivery and operations, presentations on the areas of excellence, Q&A with senior leadership and facilitated, action-oriented debriefs.

Though it’s exciting to witness actual operations, the areas of excellence for each innovator provide particularly relevant lessons.

Take the LV Prasad Eye Institute, which has been innovating eye care delivery in India for more than 25 years. LV Prasad provides a full range of eye care services with quality outcomes that rival the best institutions in the U.S. and U.K. But through an innovative operational model, LV Prasad is able to provide this high-quality care to any patient, regardless of ability to pay. While approximately half of their care is provided entirely free, LV Prasad is financially sustainable and continues to expand. They deploy right-skilling and task-shifting workforce models, and integrate community health outreach with secondary and tertiary centers of care.

Vaatsalya Healthcare, another participating innovator, has developed a sustainable and replicable model of primary and secondary care delivery for small towns and rural areas in India. Their network chain of 16 hospitals (and growing) has reduced cost of care through business model innovation to ensure that low- and moderate-income families can afford high-quality care. Their standardized procedures that support a high volume of surgical procedures, as well as vertical expansion through culture of innovation, facilitate their continued growth.

Many readers will be familiar with LifeSpring Hospitals, which uses service specialization, right-skilling and a strict focus on clinical outcomes to deliver high-quality maternal care for about one-fourth the cost of other private providers, tapping into an unmet need for low- and moderate-income families in India. Their network of 12 hospitals is poised to continue expanding. LifeSpring drives quality outcomes by standardized procedures and institutionalizing best practices, deploying preferential and transparent pricing models and integrating it all with community outreach and education.

We began this story with Narayana Health. Narayana, quite impressively, has implemented lean processes to measure and increase efficiency and quality, increased access to rural and remote regions through telemedicine and successfully replicated their care delivery model in other contexts.

Dr. Prashant Deshmukh, the general manager for business development at Narayana, explains, “Innovation is the key element in Narayana Health’s DNA. Today, the health care industry needs more process innovation than product innovation. The industry does not need a magic pill or the fastest scanner or a new procedure, but instead requires improvements that lower the cost of medical attention and make it more widely available. Narayana’s breakthrough business model using economies of scale and scope has shown the world a new way to achieve affordable health care to masses.”

In fact, Deshmukh is enthusiastic not only to be part of the inaugural tour, but about how innovation can (and should) be shared globally.

“We believe our success can lead to a new health care model not only for India but perhaps also for the world. This tour is an exciting opportunity to share our experience with IPIHD’s corporate, foundation supporters and business leaders across boundaries.”

In addition to the study tour, IPIHD is furthering the discussion through two dinner events, open to leaders in India’s health care, innovation and investment communities. Attendees of the dinners include leaders from the U.K. National Health Service, U.S. health systems, the Health Foundation, Medtronic, Baxter and local health care investors, entrepreneurs and corporate leaders in the health care sector. Those interested can regsiter to attend these evening events:

Monday, Oct. 7, Bangalore dinner

Thursday, Oct. 10, Hyderabad dinner

Though we cannot promise you will see (or experience!) open-heart surgery, there will be an opportunity to convene with others interested in applying innovative lessons to your own health care system, organization or country.

In our age of virtual engagement, it’s difficult to gauge just how important in-person connections can be to the development and spread of good ideas that have the power to impact the health of millions.

Following the study tour, participants plan to spread the learning through targeted events, including a policy roundtable in the U.S. and convening meetings to further discussions in the U.K. IPIHD will also be publishing in-depth profiles on each of the participating innovators, so you’re invited to stay tuned, learn more and join the conversation by clicking here and here.

Eleni Vlachos is the Engagement Project Manager for the International Partnership for Innovative Healthcare Delivery.

Health Care
public health