Galapogos Effect - Scaling in Health Care

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This post fits in with both the concept of Scaling versus Diffusion and with Global Health Care, two issues which have been dealt with in the recent past. From Hardware to Collaborative Philosophy "Whatever it takes" dealt with scaling. This article from FastCompany by Robert Fabricant appeared in July. I find scaling versus diffusion an interesting topic and Global Health Care a good medium for exploration. Robert Fabricant takes a biological approach to global health care delivery using the Galapagos Island Effect because, "It has evolved its own ecosystem and business practices that reflect this isolation" to understand the issues from a pragmatic perspective as to how best deliver services. As usual far more information is available at the orginal article.

TB: The Galapagos Effect in Health Care

And it was very apparent at the Pacific Health Summit despite the presence of some of the most brilliant minds in public health (like Tony Fauci, Paul Farmer, and Laurie Garrett). Despite their best efforts, industry leaders continue to betray an outdated, manufacturing mindset, referring to everything that has impact in the field--that touches communities and provides real human value--as "delivery." This one-way model of engagement is truly shocking in an age dominated by communications technologies and connectivity. Health is not 'delivered' to people. It relies on active engagement and participation. It is a dialogue.

He goes on to deal with some myths that to my mind can be applied beyond the health care field which a bulleted below.

• #1: Innovation Happens in the Lab
• MDR-TB vividly demonstrates that solutions that work in the lab are not necessarily well-suited to the behavior and cultural conditions in the field. So why not build those conditions into the model from the beginning? As designers, we find those conditions to be inspiring.
• 2: Innovation Only Flows in One Direction
• The prevailing direction of health-care innovation is not just from lab to field but also from first to third world. The "business" of delivering global health services was a post that featured both Dr. Ernest Madu: Creative ways to bring health care to the poorest and #Dr. Seyi Oyesola: Rich hospital, poor hospital
• #3: The Field is Messy
• The article points out that it is humans that are messy. This challenges us, "to think more broadly about human needs and behavior. To step outside the narrow lens of a particular condition."
• #4 Innovation must be Market-Driven
• The myth is that impact cannot be scaled and maintained without a market mechanism. This goes back to the idea of scalability as defined by market know-how. But as pointed out in the article, "does it hold equally true to scaling up access, outreach and support? How innovative are the large multi-nationals in this area particularly in relation to the routine and chronic diseases of the poor?"

From Hardware to Collaborative Philosophy "Whatever it takes"

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Social Entrepreneurship blogger Nathaniel Whittemore's had a post which has been sitting in my draft box for some time. It was on a comparison of Scale vs. Diffusion. His focus was about how to "scale" social sector innovation, and whether "diffusion" might be a more useful idea.

He followed up with another post on Understanding Scale. There is a great deal of interesting insights in the comments sections of both posts. This brings this blogging effort full circle returning to concept of "Creative Destruction" in my first blog which lead me along the path to where I find myself today. Also touches upon "Disruptive Innovation" from earlier in this blog. The concept of in-bound marketing is now taking root in empowering people.

The response to the post demonstrated a nerve was hit and that many social entrepreneurs are thinking hard about how to reevaluate the notion of "scale." It has taken me some time to get my head around it and I will be coming back to these concepts. In very simplistic terms, scaling is bricks and diffusion is water. Use both and you can turn grain into bread. Here is a quick bullet list, more at the original posts.

• Comment Theme #1 - Finally, "Scale" Isn't Sacrosanct:
• Comment Theme #2 - Affirmation of Local Context: Diffusion necessarily gives local context a stronger hand in adapting an innovation to meet a particular and discreet set of needs.
• Comment Theme #3 - Mind Shift, Not Resource Increase: Foundations still had a potentially vital role fostering the ecosystems in which innovation could diffuse across networks, and that a mindset shift was more important than any sort of resource increase.
• Comment Theme #4 - Institutional Scale Still Matters: A final point was that the "diffusion" mindset doesn't entirely supplant our notion of scale as much as supplements it.
  

What I also found interesting was the examples provided. They demonstrate a pathway from hardware technology create to solve a specific problem to organizational adoption to collaborative strategies. Paul Farmer's work has been featured in this blog and earlier in my first blog.

• FrontlineSMS: A free, large scale text messaging solution for NGOs and non-profit organizations

  FrontlineSMS is free open source software that turns a laptop and a mobile phone into a central communications hub.
  

  • A lack of communication can be a major barrier for grassroots non-governmental organisations (NGOs) working in developing countries. FrontlineSMS is the first text messaging system created exclusively with this problem in mind.

    FrontlineSMS leverages computers and mobile phones already available to most NGOs enabling instantaneous two-way communication on a large scale.
    

• jopsa.org - Projects and perspectives on global health

  The FrontlineSMS in action

  • From the start of our projects to the finish, it’s people who determine what FrontlineSMS:Medic does, when we do it, and why. The tech tools we use exist to serve patients, community health workers, and healthcare professionals – not the other way around.
    

    We strongly believe that projects should start when clinics ‘pull’ them to a site, as opposed to having projects ‘pushed’ onto healthcare providers..

• FrontlineSMS:Medic | Text Messages Save Lives

  Implementing the Millennium Development Goals health objectives in the developing world will require new technologies arising from disruptive innovation. Finding new uses for technologies we take for granted.
  

  • How powerful is a light-weight tool in the right hands? During a six month pilot in Malawi, our partner doubled the number of people being treated for Tuberculosis.

  • Driven by local ownership and appropriate technology.

    In the developing world, lack of infrastructure prevents health workers from delivering efficient healthcare to rural areas. As health workers travel from clinics to reach isolated patients, they are often as disconnected from central clinics as the patients they are trying to serve. The mission of FrontlineSMS:Medic is to advance healthcare networks in the developing world by building and distributing innovative, appropriate mobile technologies.

• Partners In Health Vision - Whatever it takes

  The PIH model of care – partnering with poor communities to combat disease and poverty
  
  For the first time, substantial funding is available to treat infectious diseases in impoverished settings. Funding alone, though, won’t be enough. For this massive investment to make a real impact on the twin epidemics of poverty and disease, a comprehensive and community-based approach is key.

  • The PIH Vision: Whatever it takes
  • At its root, our mission is both medical and moral. It is based on solidarity, rather than charity alone.
    
  • Whatever it takes. Just as we would do if a member of our own family—or we ourselves—were ill.

Diigo tags: frontlinesms, mobile, global health vision, mdgs jopsa.org, jopsa, sms, activism, development,

Posted from Diigo. The rest of my favorite links are here.

Innovation, Disruptive Milestones for the New Millennium

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Some articles of interest from the New York Times, this time on innovation. I was originally going to post this at the other blog. If we are to create a sustainable economy under a free enterprise system that is to be of benefit to the world as a whole and not to a privileged few, we will have to depend greatly upon innovation. A concern for some is that the United States is losing its innovative edge. A greater concern is that we do not apply our innovation to the betterment of mankind.

TECHNOLOGY | February 25, 2009 In Innovation, U.S. Said to Be Losing Competitive Edge By STEVE LOHR

The U.S. ranks sixth among 40 countries and regions for innovation, a nonpartisan group noted in a report.

The report by the Information Technology and Innovation Foundation found that the United States ranked sixth among 40 countries and regions, based on 16 indicators of innovation and competitiveness. They included venture capital investment, scientific researchers, spending on research and educational achievement.

Disruptive Innovation seems to me to be the Twenty-first Century update to Creative-Destruction, and of far greater utilization to entrepreneurs, social or private. The fact that it is currently being applied to the medical field also means it is applicable to global health issues being faced by Millennium Development Goal 6. Combat HIV/AIDS and other diseases. In truth, those who have been involved in facing health challenges in developing countries have been using disruptive technologies out of necessity. The New York Times article below provides a basic look at the issues and the MIT video following provides greater insight from the author of the concept Clayton M. Christensen.

BUSINESS | February 01, 2009 Unboxed: Disruptive Innovation, Applied to Health Care

Using innovation management models previously applied to other industries, Clayton M. Christensen, a Harvard Business School professor, argues in “The Innovator’s Prescription” that the concepts behind “disruptive innovation” can reinvent health care. The term “disruptive innovation,” which he introduced in 2003, refers to an unexpected new offering that through price or quality improvements turns a market on its head.

The Innovator's Prescription: A Disruptive Solution to the Healthcare Crisis

Christensen distills several books' worth of research describing how business leaders sometimes metamorphose into losers when confronted with market-rocking innovations. He also reveals how we may harness his insights in such socially significant and complex industries as healthcare.

The final question is what does one need to strive in such an environment. The answer below is taken from the private sector, but I believe, as I so often do, that there are important lessons to be taken from the private sector in creating a sustainable, efficient and effective system for delivering public services and social goods.

Corner Office: The Keeper of That Tapping Pen By ADAM BRYANT Anne M. Mulcahy, who led a turnaround at Xerox, says it "learned a lot about identifying failure quickly."

Q. Do you find yourself looking for certain qualities in a candidate more than you did several years ago?

A. Adaptability and flexibility. One of the things that is mind-boggling right now is how much we have to change all the time. For anybody who’s into comfort and structure, it gets harder and harder to feel satisfied in the company. It’s almost like you have to embrace a lot of ambiguity and be adaptable and not get into the rigidness or expectation-setting that I think there used to be 10 years ago, when you could kind of plot it out and define where you were going to go.

Related Posts:

• The "business" of delivering global health services
• Working Together Learning, Managing and Doing Change