Frugal innovation in healthcare -- Keynote speech by Dr Yasser Bhatti
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This document provides information about a presentation on frugal innovation in healthcare. It includes: 1) An overview of the presenter's background working on frugal innovation at Imperial College London and previous research on innovation, strategy, and entrepreneurship. 2) Examples of different approaches to innovation at the base of the pyramid, including grassroots innovation, reverse innovation, and frugal innovation. 3) Details on two case studies of frugal innovations - a $10,000 medical procedure brought to $1,000 and examples of low-cost, high-volume eye and cardiac surgeries in India. 4) Discussion of the need for frugal innovations to establish affordable
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Frugal innovation in healthcare -- Keynote speech by Dr Yasser Bhatti
- 1. Makeathon Innovation Without Borders 2019: Imperial College London 12 Jan 2019; 11:15am – 11:45am Yasser.Bhatti@imperial.ac.uk Frugal innovation in healthcare
- 2. What do I do ? • 2018-Current: Honorary Lecturer at Imperial, Lecturer at Queen Mary and New College, Oxford • 2014-7: Research Fellow in Frugal Innovation at the Imperial’s Institute for Global Health Innovation. • 2009-14: PhD research at Oxford was on innovation, strategy, and entrepreneurship. • My background from Pakistan as developing country motivated me to focus on leveraging innovation in healthcare sector.
- 3. Adopting new ways in innovation • Base of the Pyramid Innovation • Grassroots Innovation • Reverse Innovation • Jugaad Innovation • Frugal Innovation 3
- 4. Articles in Emerging Trends in Innovation
- 8. Bhatti © 2014 8 Flow of innovation Reverse flow of innovation
- 9. Flow of innovation Reverse flow of innovation
- 11. 2 Rooms-1 Cooler
- 12. https://pci-360.com/plastic-bottles-as-inhaler-spacers-improving-the-effectiveness-of-healthcare-using-clinical-skills/ Spacers can be hard to find in low- and middle-income countries. But you can make a perfectly good one for free from something that otherwise litters the environment everywhere: a small, empty, plastic drinking- water bottle.
- 14. Study of two communities of innovators and entrepreneurs. 1. Global Social Business Incubator (Santa Clara) 2. Design for Extreme Affordability (Stanford) • 163 business plan document summaries, • 81 interviews with entrepreneurs, investors, and academics, and • 2 months of observations at an annual intensive social entrepreneurship and innovation ‘boot-camp’. http://www.cambridge.org/97811071 88976
- 15. Why are frugal innovations needed for global healthcare? High-Income Countries • Ageing populations • Increased burden of chronic disease • Exponential cost of healthcare delivery Low and Middle-Income Countries • Establishing healthcare systems where previously care has been sporadic and of poor quality Photo of Malawi Clinic, Courtesy of Matthew Prime
- 16. Examples Videos • GE – https://www.youtube.com/watch?v=yB47wx-b6sY – https://www.youtube.com/watch?v=TBjvCU9tdfQ • Narayana – https://www.youtube.com/watch?v=xmHXOcgvCdo – https://www.youtube.com/watch?v=L15fD477Pio&t=138s • Aravind – https://www.youtube.com/watch?v=3cjnNPua7Ag • Arbutus – https://vimeo.com/116393761 • Hernia Mesh – http://www.bbc.co.uk/news/av/health-24397202/mosquito-nets-used-in-hernia- repair
- 18. Procedures per year Cost of similar procedure in the US Aravind Eye Care 240,000 50x Narayana Health 7,500 30x The Innovation Sandbox, Prahalad 2006 Famous Frugal Innovations both Surgical
- 19. Ophthalmic Surgery: Aravind Eye 19 https://www.youtube.com/wa tch?v=3cjnNPua7Ag
- 20. Cardio-thoracic Surgery: Narayana 20 WSJ.com (2009) Quantity and QUALITY 28 day mortality is 1.4% rather than 1.7% in Cleveland Clinic https://www.youtube.com/watch?v=_fhEW-LfWes
- 23. 23 Surgical and Household Drill Bosch Drill: Same speed Same torque Lightweight Bosch Batteries: Longer lasting charge Longer life Very low cost https://youtu.be/YbWD6u5O45g
- 24. C o s t P e r f o r m a n c e Cheap Frugal Standard Bhatti © 2018 24 Frugal is not Cheap Experimental Suboptimal Good Enough High Performance
- 25. Overlay of two figures in support of the finding that frugal innovation is not cheap Image source: Bhatti et al, 2018. Frugal Innovation – Models, Means, Methods. Cambridge University Press. Cheap Frugal Luxury Experimental
- 27. Frugal Innovation Dimensions Bhatti © 2016
- 28. Social Innovation Affordability constraints Institutional Innovation Technology Innovation Institutional voids Resource constraints Frugal innovation is difficult More than Technology
- 29. The team realized that designing for inspiration and end users was not enough. It had to design also for manufacture and distribution.
- 30. Keys lessons • Needs and ideation locally identified in developing countries • But draw from best practices in other sectors, innovations, and from developed countries • Scale up in mostly developing countries
- 31. Make time and space for learning and adopting new ways of working
- 32. Enjoy Design and Good luck !
Editor's Notes
- I focus on innovation under constraints; the localisation and globalisation of innovation; the role of emerging market economies and; situated actors such as social entrepreneurs in emerging trends in innovation; particularly frugal innovation and reverse innovation.
- 2004
- 2016
- Year of publication of Agtmael? 2007 Next 11 Bangladesh, Egypt, Indonesia, Iran,Mexico, Nigeria, Pakistan, the Philippines, Turkey, South Korea and Vietnam – identified by Goldman Sachs investment bank
- Year of publication of Agtmael? 2007 Next 11 Bangladesh, Egypt, Indonesia, Iran,Mexico, Nigeria, Pakistan, the Philippines, Turkey, South Korea and Vietnam – identified by Goldman Sachs investment bank
- Improvisation, bricolage
- Difference between jugaad and frugal ?
- “How well could you use an asthma inhaler? How well could you teach someone else to use one? They’re tricky. Don’t forget to shake it first. Hold it the right way up. Seal your lips around it: people seem to find that hard. Then — this is the really tricky bit — co-ordinate releasing the dose of medication as you inhale, so it’s carried down into your lungs and doesn’t end up on the back of your throat, or wafting out into the atmosphere. After that, hold your breath for a few seconds. And then repeat. I find it hard. It can be almost impossible for smaller children, or if you’re not very co-ordinated, or if when stressed because you’re finding it hard to breathe. It’s lots easier, and more effective, if you use a spacer — a chamber (with a mask, for small children) into which the medication is released, making it less important to co-ordinate your breathing just so. People often think of spacers as being for children, but I suggest to all my own patients that they use a spacer whenever they can.
- Colloquial definition of Frugal: sparing or economical with regards to money Bricolage, french, DIY, improvisation, making do with whats on hand
- Image source: http://marketinghightech.net/the-book/chapter-4/ch4-aravind Aravind’s social mission is to provide “sight for all and to see everyone as one” Since 1976 Aravind Eye Hospital has been on a mission to end blindness in India seeing 2.5 million patients a year, conducting 350K eye surgeries a year, and gross margin of 40% despite that 70% of patients receive free or heavily subsidized rates. Costs tens of dollars versus 1000 dollars plus. With less than 1% of the country's ophthalmic manpower, Aravind accounts for 5% of the ophthalmic surgeries performed nationwide $200 a piece to locally produced $5 a piece, costs $10 to conduct a cataract operation that lasts just 20 minutes. The hospital's Aurolab pioneered the production of high-quality, $5 low-cost intraocular lenses producing 700,000 lenses a year, of which three quarter are exported all over the world. However, the lenses are not exported to the US since Aravind cannot afford the costly US-FDA clinical approval process (Rubin 2007).
- NH's average cost of a bypass surgery is $1,500 (Rs 90,000) compared to $44,000 in the US With a (EBITDA) margin is a healthy 13 per cent Private equity funds JPMorgan and Pine Bridge have picked up a 24 per cent stake in NH. Task shifting, specialist tasks, Ford's assembly line high volumes, JIT zero inventory It leases some on a pay per use basis. Ascension largest non-profit health system in the U.S. and world's largest Catholic health system. 28 day mortality is 1.4% rather than 1.7% in Cleveland Clinic
- NEJM Jan 2016: Hernia repair is the most common operation in the world (20 million operations performed annually), but Dr Tongaonkar's (2003) Commercial nets cost more than $100 versus open market nets can cost around $2.50
- Over 9 million above-knee amputees in the developing world do not have access to the prosthetics $5K to less than $50 per knee
- Resource constraints: (tangible in terms of technology, capital, labor) or intangible skills, knowledge Technology innovations, tools, machinery and devices developed from scientific knowledge A social innovation is a novel solution to a social problem that is more effective, efficient, sustainable, or just than current solutions. The value created accrues primarily to society rather than to private individuals. Institutional innovation: norms, behaviors, practices, regulations need for an efficient market economy, soft (contract enforcement, legal recourse, credit worthiness, capital markets) hard, (infrastructure, roads, ports, water supply, electric grid)
- Find out how to defend Institutional and Business innovation overlap! Innovation under three or any two of the three constraints is Frugal innovation Any two of three sandbox constraints foster frugal innovation