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The
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th care xecu E
TOMORROW G N R Overlapping Revolution
VOLUME 15
Unlocking the Power of Creative Medicine Reverse Innovation 3D Printing in Healthcare Dr. Watson The power of Exponential Medicine
We are in the midst of a (medical) revolution driven by exponential technology: artiď€ cial intelligence, sensors, robotics, 3D printing, big data, genomics and stem cells. Today's $3 trillion healthcare industry is in the deceptive phase of its march towards dematerialization, demonetization and democratization. WHAT DOES THAT MEAN?
A JOURNEY INTO
TOMORROW Healthcare Management Review PAGE Volume 15 003
His Excellency, Muhammadu Buhari, GCFR giving oral polio vaccine (OPV) to his grand-daughter to mark
One Year without Polio in Nigeria
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31 SPOTLIGHT:
G N R O V E R LA P P I N G R E V O LU T I O N GNR O V E R LA P P I N G
R E V O LU T I O N
Unlocking
the Power of
Creative Medicine
31
REVERSE
Innovation
58
Prof A. O Emeribe
46
& the Future of Medicine
69
Healthcare Management Review PAGE Volume 15 009
Disruptive
Innovation Rules are being
REWRITTEN Industry boundaries
REDRAWN Prevailing truths
CHALLENGED
EVOLUTION OF STEM CELLS AND THEIR APPLICATION IN MODERN MEDICAL THERAPEUTICS IN NIGERIA.
3D Printing in Healthcare
74
Acheilefu
FUNDAMENTALS TRANSFORMING THE HEALTH SYSTEM
Destruction
96
Dr. Watson
Come Here
82
I Need You
100
86
The Power of Exponential Medicine
108
88
2015 - 2030 Timeline
112
Dr. Samuel CA N C E R- S E E I N G G LA S S E S
Creative
Healthcare Management Review PAGE Volume 15 011
The following organizations have demonstrated their commitment to healthcare leadership and management in Nigeria.
T H IN S U R A AL
N S CE CHEM E
TIONAL H NA E
FEDERAL MINISTRY OF HEALTH NIGERIA
hfn ENGAGEMENT
PMG
ACCESS
QUALITY
MAN
Pharmaceutical Manufactures Group of Manufacturers Ass. of Nig. (PMG-MAN)
Healthcare Management Review PAGE Volume 15 013
EDITOR IN CHIEF Emmanuel C. Abolo
@rovahmr www.facebook.com/rovahealthmgt www.linkedin.com/in/rovahmr
SENIOR EDITORS Godwin Odemijie Moji Makanjuola INTERNATIONAL AFFAIRS BUREAU CHIEF Jeff Flint DIRECTOR - EDITORIAL OFFICE Nkechi D. Abolo STAFF GRAPHIC DESIGNER
James David Chinedu Iroegbulam SCRIPT EDITOR
Tinuke Obikoya RCHE FACULTY ADVISORS
Prof. Rowland Ndoma-Egba Prof. Femi Adebanjo Prof. Okey Mbonu Dr. Ibrahim Wada Dr. Emmanuel C. Abolo (Jnr) Dr. A Dutse Dr. Kabiru Mustapha Barr. Charles Okei Mr. Fidel Anyanna Oluwakemi Lawanson CREDITS
Marketing Partner
Raymond Kurzweil Richard Feynman Aubrey De Grey Dr. Ibrahim Wada VIJAY Govindarajan Dr. Prosper I. Igboeli Prof. A. O. Emeribe Dr. Samuel Acheilefu Dr. Christopher U. Otabor
VENTOLITE MARKETING INT’L. LTD.
Healthcare Management Review PAGE Volume 15 015
E D I T O R I A L
THE END OF
PRIMITIVE MEDICINE
T
he healthcare profession is in the midst of a revolution in mission and purpose. The work design of the past satisfy neither patient nor workers and the hospital system.
There is nothing wrong with medicine today except that it does not have the knowledge and tools to do the job. Medicine as we know it is woefully unprepared to deal with its primary charge of eliminating disease. We bombard cancer, attempting to kill it with radiation, antibiotic mount assault on infections. We surgically curve out diseased tissues as a routine practice. An amazing array of drugs has more side eects than the illness or the problem they were designed to address. Medicine is only performing at its current level of discovery. What we call modern medicine is quite primitive and can accomplish so much until we invent new tools. We need to understand why medicine will change and how it will change. Caregivers are only waiting for the next generation of innovation tools that will enable them to do more to heal, restore and prevent disease. Most disease begins at the atomic level, where subtle interaction between DNA, genes, the environment, and other parts of the body and mind interact. We do not yet have the tools in medicine to see and understand this atomic level of human body. By the time disease happens we are way down stream in the organs and tissue. By the time you feel the lump in your breast, experience pain or notice something is wrong,
Healthcare Management Review PAGE Volume 15 016
disease has already moved to organs or tissues. What if we can look into human atomic and DNA to identify the potential triggers that form the disease? What if we can turn off the triggers? This will result in increased health, save billions of naira, and enhance the quality of human existence. Healthcare today is reactive, retrospective, bureaucratic and expensive. We are in the midst of a (medical) revolution driven by exponential technology: artificial intelligence, sensors, robotics, 3D printing, big data, genomics and stem cells. Today's $3 trillion healthcare industry is in the deceptive phase of its march towards dematerialization, demonetization and democratization. Human imagination has continued to take medical science into a bold new future we often struggle to understand. There is a new medicine emerging, born out of an overlapping GNR revolution – a fusion of genetic, nanotechnology and robotic/artificial intelligence. It is expanding adjacent possibilities, creating an emerging multibillion dollar market. The future of medicine will anchor on longitivity – changing everything. The innovation will shock too many at first, but so was voice mail and internet. This future is inevitable given the exponential rate of the GNR overlapping revolution. We have to rethink the future of healthcare, packaging the right answer in a way that meets people where ther are and how they want to receive it. In 15years, when we look back at history, we will marvel at how little we know about the world of medicine and realize that compared to what we ought to know, we are half awake. Medicine is primed today for tomorrow.
Healthcare Management Review PAGE Volume 15 017
Innovation in health care delivery
Healthcare Management Review PAGE Volume 15 018
is taking place around the world
Turning the World Upside Down The search for global health in the 21 Century Healthcare Management Review PAGE Volume 15 019
PERSONALITY
THE RESTLESS
GENIUS Best known for gorilla assault on conventional wisdom
Ray's technology and ideas have truly been among the s u n s h i n e s of my l i f e . Kurzweil's writings are
With his brillant description of the coming connections of computers with immortality,
wonderful, ri on the next
Kurzweil clearly takes his
century from a keen seer, a
place as a leading futurists.
good inventor and a good friend. -Steve Wonder
-MITs. Marvin Minsky
Healthcare Management Review PAGE Volume 15 020
te ine a im ach t l u m The king thin the "righ tf Thomas ul heir to Edison."
Raymond "Ray" Kurzweil Raymond "Ray" Kurzweil born February 12, 1948 is an American author, computer scientist, inventor, futurist, and is a director of engineering at Google.
recreating the grand piano and other orchestral instruments, and the first commercially marketed large-vocabulary speech recognition.
Ray Kurzweil is one of the world's leading inventors, thinkers, and futurists, with a thirty-year track record of accurate predictions. Called "the restless genius" by The Wall Street Journal and "the ultimate thinking machine" by Forbes magazine, Kurzweil was selected as one of the top entrepreneurs by Inc. magazine, which described him as the "rightful heir to Thomas Edison." PBS selected him as one of the "sixteen revolutionaries who made America.”
Among Kurzweil's many honors, he recently received the 2015 Technical Grammy Award for outstanding achievements in the field of music technology; he is the recipient of the National Medal of Technology, was inducted into the National Inventors Hall of Fame, holds twenty honorary Doctorates, and honors from three U.S. presidents.
Kurzweil was the principal inventor of the first CCD flat-bed scanner, the first omni-font optical character recognition, the first print-to-speech reading machine for the blind, the first text-to-speech synthesizer, the first music synthesizer capable of
Ray has written five national best-selling books, including New York Times best sellers The Singularity Is Near (2005) and How To Create A Mind (2012). He is a Director of Engineering at Google heading up a team developing machine intelligence and natural language understanding.
Healthcare Management Review PAGE Volume 15 021
Healthcare Management Review PAGE Volume 15 022
O V E R LA P P I N G
Ray
T
he first half of the 21st century will be characterised by three overlapping revolutions in GENETICS, NANOTECHNOLOGY, and ROBOTICS. We are in the early stages of 'G' revolution today. By understanding the information processes underlying life, we are starting to learn to reprogram our biology to achieve the virtual elimination of disease, dramatic expansion of human potential, and radical life extension. The 'N' revolution will enable us to redesign and rebuild – molecule by molecule – our bodies and brains and the world with which we interact, going far beyond the limitation of biology. The most impending revolution is 'R': human-level robots with their intelligence derived from our own but redesigned to far exceed human capabilities. R.
Kurzweil
represents the most significant transformation, because intelligence is the most powerful “force” in the universe. Intelligence, if sufficiently advanced, is, well, smart enough to anticipate and overcome any obstacles that stand in its path. While each revolution will solve the problem from earlier transformations, it will also introduce new perils. G will overcome the age-old difficulties of disease and aging but establish the potential for new bioengineered viral threats. Once N is fully developed, we will be able to apply it to protect ourselves from all biological hazards, but it will create the possibility of its own self-replicating danger, which will be far more powerful than anything biological. We can protect ourselves from these hazards with fully developed R, but what will protect us from pathological intelligence that exceeds our own? Healthcare Management Review PAGE Volume 15 023
THE GENETIC REVOLUTION THE INTERSECTION OF INFORMATION AND BIOLOGY
“After three billion years of evolution, we have before us the instruction set that carries each of us from the one-cell egg through adulthood to the grave.”
Dr. Robert Waterston, International Human Genome Sequencing Consortium
I M P L I C AT I O N S LONGITIVITY MEDICINE
T
here are three bridges to radical life extension: today's knowledge, biotechnology and nanotechnology. Sufficient information already exist today to slow down disease and aging. Applying the knowledge we have today, we can overcome our genetic heritage in the vast majority of cases. It's mostly in your genes. Biotechnology will provide the means to actually change your genes: not just designer babies will be feasible but designer baby boomers. We will also be able to rejuvenate all of your body's tissue and organs
by transforming your skin cells type. Already, new drug development is precisely targeting key steps in the process of atherosclerosis (the cause of heart disease), cancerous tumour formation, and the metabolic processes underlying each major disease and aging process. Aging is not a single inexorable progression but as a group of related processes. Strategies are emerging for fully reversing each of these aging progressions, using different combinations of biotechnology techniques. The diverse field of biotechnology is fuelled by our accelerating progress in reverse engineering, the Healthcare Management Review PAGE Volume 15 024
information process underlying biology and by a growing arsenal of tools can modify these processes. For example, drug discovery was once a matter of finding substances that produced some beneficial result without excessive side effects. Today we are learning the precise biochemical pathway that underlie both disease and aging processes and are able to design 'smart' drugs to carryout precise missions at the molecular level. The scope of these efforts are vast. Another powerful approach is to start with biology's information back-bone: the genome. With recently developed gene technologies, we are on the verge of being able to control how genes express themselves. Gene expression is the process by which Specific Cellular Components (specifically RNA and the ribosomes) produce proteins according to a specific genetic blue print. While every human cell has the full complement of the body's genes, a specific cell, such as a skin cell or pancreatic islet cell, gets its characteristics from only the small fraction of genetic information relevant to that particular cell type. The therapeutic control of this process can take place outside the cell nucleus, so it is easier to implement than therapies that require access inside it. Gene Chips: New therapies are only one way that the growing knowledge base of gene expression will dramatically impact our health. Since the 1990s microarrays, or chips no larger than a dime, have been used to study and compare expression patterns of thousands of genes at a time. The possible application of the technology are so varied and the technological barriers have been reduced so greatly that huge databases are now devoted to the results from “do-ityourself gene watching”.Genetic profiling is now being used to: Revolutionize the processes of drug screening and discovery: Microarrays can “not only confirm the mechanism of action of a compound” but
“discriminate between compounds acting at different steps in the same metabolic pathway”. Improve cancer classifications: One study reported in science demonstrated the feasibility of classifying some leukemias “solely on gene expression monitoring”. The authors also pointed to a case in which expression profiling resulted in the correction of a misdiagnosis. Identify the genes, cells, and pathways involved in a process, such as aging or tumorigenesis: For example, by correlating the presence of acute myeloblasticleukemia and increased expression of certain genes involved with programmed cell death, a study helped identify new therapeutic targets. Determine the effectiveness of an innovative therapy: One study recently reported in bone looked at the effect of growth-hormone replacement on the expression of insulin-like growth factors (IGFs) and bone metabolism markers. Test the toxicity of compounds in food additives, comsmetics and industrial products quickly and without using animals: Such test can show, for example, the degree to which each gene has been turned on or off by a tested substance. Somatic Gene Therapy: (Gene therapy for nonreproductive cells) This is the holy grail of bioengineering, which will enable us to effectively change genes inside the nucleus by “infecting” it with new DNA, essentially creating new genes. The concept of controlling the genetic makeup of humans is often associated with the idea of influencing new generations in the form of designer babies. But the real promise of gene therapy is to actually change our adult genes. These can be designed to either block undesirable diseaseencouraging genes or introduce new one that slow down and even reverse aging processes. Healthcare Management Review PAGE Volume 15 025
NANOTECHNOLOGY R E V O L U T I O N
Miniaturization and Cost-reduction Trends
NANO-MEDICINE
T
he next effect of these nano-medical interventions will be the continuing arrest of all biological aging, along with the reduction of current biological age to whatever new biological age is deemed desirable by the patient, severing forever the thinking between calendar time and biological health. Such interventions may become common place several decades from today. Using annual check-ups and clean cuts, and some occasional major repairs, your biological age could be restored once a year to the more or less constant physiological age that you select. You might still eventually die of accidental causes, but you will live at least ten times longer than you do now. A prime example of this application of precise molecular control in manufacturing will be the development of billions of trillions of nanobots: small robots the size of human blood cells or smaller that can travel inside the bloodstream.
Considering several examples of nanobot technology, which, based on miniaturization and cost-reduction trends, will be feasible within twentyfive years. In addition to scanning the human brain to facilitate its reverse engineering, these nanobots will be able to perform a broad variety of diagnostic and therapeutic functions. ARTIFICIAL BLOOD Robert A. Freitas Jr. a pioneering nanotechnologist theorist and leading proponent of Nanomedicine (reconfiguring one biological systems through engineering on a molecular scale), and author of a book with that title – has designed robotic replacements for human blood cells that perform hundreds or thousands of times more effectively than their biological counterparts. Healthcare Management Review PAGE Volume 15 026
The Role of the Infinitely Small is Infinitely Large Nanotechnology has the potential to enhance human performance, to bring sustainable development for materials, water, energy, and food, to protect against unknown bacteria and viruses, and even to diminish the reasons for breaking the paces (by creating universal abundance).
Louis
With Freitas respirocytes (robotic red blood cells) a runner could do an Olympic sprint for fifteen minutes without taking a breath. Freitas's robotic microphages called “microbivores”, will be far more effective than our white blood cells at combating pathogens. His DNA-repair robot would be able to mend DNA transcript errors and even implement needed DNA changes. Other medical robots he has designed can serve as cleaners, removing unwanted debris and chemicals (such as priors, malformed proteins, and protofibrils) from individual human cells. Freitas provides detailed conceptual designs for a wide-range of medical nanorobots (Freitas preferred term) as well as a review of numerous solutions to the varied design challenges involved in creating them. Although Freitas's conceptual designs are a couple of decades away, substantial progress has already been
Pasteur
made on bloodstream-base devices. For example, a researcher at the University of Illinois at Chicago has cured type 1 diabetes in rats with nanoengineered device that incorporates pancreatic islet cells. The device has seven-nanometer pored that lets insulin out but won't let in the antibodies that destroy these cells. There are many other innovative projects of this type already underway. An analysis by Robert A. Freitas Jr. indicates that replacing 10percent of a person's red blood cells with robotic respirocytes would enable holding one's breath for about four hours, which is about 240 times longer than one minute (about the length of time feasible with all biological red blood cells) since this increase derives from replacing 10percent red blood cells, the respirocytes are thousands of times more effective. Healthcare Management Review PAGE Volume 15 027
National Science Foundation Nanotechnology report Nanotechnology promised the tools to rebuild the physical world – our bodies and brains included – molecular fragment by molecular fragment, potentially atom by atom.
Feynman
Richard Seminar Speech in 1959 “There is plenty of room at the bottom”
“The principles of physics, as far as I can see, do not speak against the possibility of manoeuvring things atom by atom. It would be, in principle, possible … for a physicist to synthesize any chemical substance that the chemist write down…How? Put the atoms down where the chemist says, and you make the substance. The problems of chemistry and biology can be greatly helped if our ability to see what we are doing, and to do things on an atomic level, is ultimately developed – a development which I think cannot be avoided. Healthcare Management Review PAGE Volume 15 028
THE ROBOTIC REVOLUTION & A RT I F I C I A L I N T E L L I G E N C E
O
f the three primary revolutions (G N & R), the most important is R., which refers to the creation of artiďŹ cial intelligence that exceeds that of unenhanced humans while the R in the GNR stands for Robotics, the real issue involved here is Strong ArtiďŹ cial Intelligence that exceeds human intelligence. The standard reason for emphasizing robotics in this formulation is that intelligence needs an embodiment, a physical presence, to affect the world.
solve. Disease, poverty, environmental destruction, unnecessary suffering of all kinds: these are things that a super-intelligence equipped with advanced nanotechnology would be capable of eliminating. As revolutionary as nanotechnology will be, strong A1 will have far more profound consequences. Nanotechnology is powerful but not necessarily intelligent. We can devise ways of at least trying to manage the enormous powers of nanotechnology, but super intelligence innately cannot be controlled.
It is hard to think of any problem that a super intelligence could not either solve or at least help us Healthcare Management Review PAGE Volume 15 029
Leonardo & the Art of Medicine Healthcare Management Review PAGE Volume 15 030
Leonardo da Vinci's anatomical drawings were "startling" in their accuracy, new medical scans have shown, putting him hundreds of years ahead of his peers.
H
e has long been praised as one of the finest artists of the Renaissance, working far ahead of his time and producing some of the world's most recognisable works.
But Leonardo da Vinci has finally received the credit he deserves for his “startling” medical accuracy hundreds of years in advance of his peers, as scientists match his anatomical drawings with modern day MRI scans“Five hundred years on, coMartin Clayton, exhibition curator, said the project was intended to examine the medical relevance of Leonardo's “astonishing” drawings for the first time. Speaking at the launch of the Edinburgh International Festival, he admitted it had been a “voyage into the unknown”, which could have led to the conclusion Leonardo's work was simply of historic curiosity, irrelevant to modern day anatomists” Instead, he revealed, doctors found the detailed drawings were “startling” in their accuracy. The pictures, largely produced in the winter of 1510- 1511 when Leonardo completed around 20 dissections, show the muscles, bones and sinews of the human body. One, of the heart, comes “agonisingly close” to showing how the pump action worked, with the movement of blood remarkably similar to that in a modern day medical video. The artist also produced the first accurate depiction of the spine, as well as drawing a child in the womb in the correct position. The Leonardo da Vinci: The Mechanics of Man exhibition, part of the festival showing the influence of technology on art, will open at The Queen's Gallery, Palace of Holyroodhouse, in August. It will be based on Leonardo's 'Anatomical Manuscript A', on which he crammed more than 240 individual drawings and notes running to more than 13,000 words in his distinctive mirror-writing. Comparisons with CT and MRI scans show that Leonardo's work is still relevant to scientists today,” Credit Mr Clayton “Royal Collection Trust's association with the Edinburgh International Festival, Healthcare Management Review PAGE Volume 15 031
da Vinci
Surgical System
Healthcare Management Review PAGE Volume 15 032
450-da-vinci-system da Vinci robotic surgery is ideal for minimally invasive cancer surgery, to treat conditions as diverse as prostate Healthcare Management Review PAGE Volume 15 033
a major obstacle is that surgery per se is not an engineered process
FUTURE APPLICATIONS
A
lthough the general term "robotic surgery" is often used to refer to the technology, this term can give the impression that the da Vinci System is performing the surgery autonomously. In contrast, the current da Vinci Surgical System cannot – in any manner – function on its own, as it was not designed as an autonomous system and lacks decision making software. Instead, it relies on a human operator for all input; however, all operations – including vision and motor functions— are performed through remote human-computer interaction, and thus with the appropriate weak AI software, the system could in principle perform partially or completely autonomously. The difficulty with creating an autonomous system of this kind is not trivial; a major obstacle is that surgery per se is not an engineered process – a requirement for weak AI. The current system is designed merely to replicate seamlessly the movement of the surgeon's hands with the tips of micro-instruments, not to make decisions or move without the surgeon's direct input. The possibility of long-distance operations depends on the patient having access to a da Vinci System, but technically the system could allow a doctor to perform telesurgery on a patient in another country. In 2001, Dr. Marescaux and a team from IRCAD used a combination of high-speed fiber-optic connection with an average delay of 155 ms with advanced asynchronous transfer mode (ATM) and a Zeus telemanipulator to successfully perform the first transatlantic surgical procedure, covering the distance between New York and Strasbourg. The event was considered a milestone of global telesurgery, and was dubbed “Operation Lindbergh”
CRITICISM
C
ritics of robotic surgery assert that it is difficult for users to learn and that it has not been shown to be more effective than traditional laparoscopic surgery. The da Vinci system uses proprietary software, which cannot be modified by physicians, thereby limiting the freedom to modify the operation system. Furthermore, its $2 million cost places it beyond the reach of many The manufacturer of the system, Intuitive Surgical, has been criticized for short-cutting FDA approval by a process known as "premarket notification," which claims the product is similar to alreadyapproved products. Intuitive has also been accused of providing inadequate training, and encouraging health care providers to reduce the number of supervised procedures required before a doctor is allowed to use the system without supervision. There have also been claims of patient injuries caused by stray electrical currents released from inappropriate parts of the surgical tips used by the system. Intuitive counters that the same type of stray currents can occur in non-robotic laparoscopic
procedures. A study published in the Journal of the American Medical Association found that side effects and blood loss in robotically-performed hysterectomies are no better than those performed by traditional surgery, despite the significantly greater cost of the system. As of 2013, the FDA is investigating problems with the da Vinci robot, including deaths during surgeries that used the device; a number of related lawsuits are also underway. From a social analysis, a disadvantage is the potential for this technology to dissolve the creative freedoms of the surgeon, once hailed by scholar Timothy Lenoir as one of the most professional individual autonomous occupations to exist. Lenoir claims that in the "heroic age of medicine," the surgeon was hailed as a hero for his intuitive knowledge of human anatomy and his well-crafted techniques in repairing vital body systems. Lenoir argues that the da Vinci's 3D console and robotic arms create a mediating form of action called medialization, in which internal knowledge of images and routes within the body become external knowledge mapped into simplistic computer coding. Healthcare Management Review PAGE Volume 15 034
INTERVIEW
Dr. Ibrahim Wada, OON
(Founder/Vice Chairman, Nisa Premier Hospital)
Healthcare Management Review PAGE Volume 15 036
HMR Interview with
Dr. Ibrahim Wada on the new frontiers of Medicine
Unlocking
the Power of
Creative Medicine
“
I think tomorrow's medicine involves where you can target an organ, and treat just that part without involving the
rest. So, you will have RNA, if you like, denatured viruses
that are primed to go only into the place of need; and I see
that as a very creative way forward. And so, designer
babies and new therapies that are coming are going to unlock the power of creative medicine.
�
Healthcare Management Review PAGE Volume 15 037
What new technologies are pushing the boundaries and challenging established criteria in in vitro fertilization? In vitro fertilization involves critical stages; one of them is to induce the ovulation in the woman, collect her eggs and collect sperm from her husband, get them fertilised in the laboratory and then transfer the embryo back into the women. So at every one of these stages there have been technological advances that have impacted positively on IVF treatment. For instance, if we consider egg and sperm quality determinations, there are many ways now that allow us to predict almost precisely the quality and numbers of eggs a woman will produce for the IVF treatment. One of the new technologies is the measurement of the anti-mullerian hormone (AMH) and coupled with ultrasound scan, the antral follicle count (AFC). For me, with these one can advise a couple to proceed with the treatment or consider other options, such as donor quality eggs or embryo adoption. One of the other technologies is that of cryopreservation. This enables the preservation of
sperms, eggs and embryos by vitrification technology. Vitrification is a very simplified form of the old technique of slows freezing with huge investment of resources that was in use, 10 to 20 years ago. Vitrification is very relevant today as it has improved preservation process to the extent that most clinics can use it; it is simple, inexpensive as before and very successful. With this, for example, women who want to delay child bearing for social or health reasons can decide to freeze their eggs, even when they do not have partners to fertilise the eggs until at a much later time. The advantage is that a young woman could come by and get her eggs preserved, if she is afraid that she could lose them over time, and at much later time when she will need it, she will be using a much younger egg with high quality at her old age. And so I think vitrification is worth mentioning as advancement in IVF treatment. The next I would like to refer to is the technology for identifying quality sperm to use for fertilising eggs. This technology, also available to the IVF practitioner, is based on much higher powered magnification to select a sperm for fertilisation. This new technology called Intracytoplasmic Morphologically Selected Sperm Injection (IMCI) is Healthcare Management Review PAGE Volume 15 038
advancement over the Intracytoplasmic sperm injection (ICSI) that has been practised since the 90s. With IMCI we are able to identify a sperm that is likely to fertilise an egg and less likely to produce an abnormal embryo. Now, from this point the advancement also in IVF is the ability to screen the embryos to be sure that they are free from chromosomal abnormalities or other diseases that is being suspected to be present. For example, in Africa, you want to be sure that if a couple is carrying the sickle cell traits that their child is not going to be sickle cell affected. And so the embryo can be screened for any kind of possible diseases. The embryo can also be screened for selection of desired sex of child. This technology, also available here in Nigeria, falls under the broad umbrella of the Preimplantation Genetic Testing, which include Preimplantation Genetic Diagnosis (PGD Preimplantation Genetic Screening (PGS).
Further, on screening and determination of quality embryos, is the use of biochemical markers and methods are currently being developed for determining embryos of greater biological quality by measuring the metabolites from the embryos as they grow in the culture medium over a time period. This study, referred to as Metabolomics, I see it as a future for embryo selection apart from even the chromosomal screening like PGD. Finally, there is a technology called Embryoscopy, this allows practitioners, especially the embryologist to have a 24 hour tab on the way the embryo is growing. As some are faster than others, some are more even than others and so even if you not sitting there for 24 hours you can monitor the growth pattern, you can rewind, view and select which embryo or cell is growing according the normal binary cell division method.
Healthcare Management Review PAGE Volume 15 039
“
The Nigerian healthcare insurance
situation looks to me like one of the
best options to create globalization,
to create quality and to create improvement.
Given the shifting external environment in healthcare delivery, how is Nisa Premier Hospital responding? We have a focus on selecting good quality man power and making sure that they are trained and retained where necessary, we have the policy to create a more reďŹ ned IT environment so that patients can access us from the outside, even on their mobile phones and their records are electronically available to us. We have the focus to improve the quality of technological for our analysis, whether radiological diagnosis, or clinical diagnosis or laboratory diagnosis. We are at making sure we are using cutting edge in all of these. And then, the environment of our practise is constantly been reorganised and upgraded and updated, so that any one that comes to our centre will know that it could be anywhere in the world. So, on the basis of man power development, on the basis of IT development and high level instrumental development and equipment, we are keeping abreast with the quality of services been offered anywhere
�
else in the world, whether it's in vitro fertilization, key whole surgery cancer screening and diagnosis, maternity services, children services, especially in neonatology services. Our aim will be to be one of the most recon with centres in the whole of Africa, not just in Nigeria. So, all of this pillars are been upgraded time by time. What trends have a high probability of impacting the healthcare sector which is irreversible and evolving in clear trajectory to open new opportunities? I think my answer to that question is with healthcare funding, because money is the blood of quality, if I can say that. The Nigerian healthcare insurance situation looks to me like one of the best options to create globalization, to create quality and to create improvement so, this is a certain change that I can't see being reversed, whether it been governmental healthcare which is NHIS, National Health Insurance Scheme, which is similar to the Medicaid in America and Medical Superannuation in the UK.
Healthcare Management Review PAGE Volume 15 040
Once people start feeling the beneďŹ ts of this, in terms of institutions, in terms of accountability, in terms of value for money, health insurance is the way to go, governmental or private health insurance. I see public-private partnership (PPP) as an irreversible trend that is coming up in the early days and the example of what we have achieved in Garki in the last 8years, should show even a person that it is the way to fast-track progress within the government healthcare sector. I encourage Federal and State government to look at partnership with the private sectors in some of the key hospitals, so that we can move very fast and in a very good competitive manner, so our people can have value for money and strive for more progress every time. How will you re-calibrate your operational models for the future? What will be the tradeoffs? Well, one of them is in terms of access to our services, our re-calibration will be to be available on the net, so that people who wants to view us, who wants to use our services can use these services, if you like, to
some extent, remotely. They can book their appointments, they can chose their time and we are also in the way to establish new mini centres in localities where we can provide certain services that they need often within their localities, while they only have to travel to the main hospital settings for big procedures, so not everybody has to travel far and wide. We think that at a point, we will be able even to take the service to the patient, who is not so ill rather than wait for the patient to come to our establishment, so that is a big project of home care. So a homecare division is as important as the in -hospital care division and we are going to have to expand in that aspect in the coming months because, what the world is changing to is putting power within the patient, you run your bank account from your room, and can access the whole world on the internet from your room, and healthcare within your own home environment is probably the next big thing that is going to come and people like ourselves have to be capable of responding to that or advancing and all that . so, this is the recalibration we are looking at. Healthcare Management Review PAGE Volume 15 041
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My position is very positive on the use of digital technology in medicine, it is also an irreversible part of our lives.
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What is your position on the use of digital technology in medicine? My position is very positive on the use of digital technology in medicine, it is also an irreversible part of our lives, IT communications with patients in an IT environment for healthcare is going to be ABC, hopefully in the next 4, 5 years and that's happening. Digital technology is already in healthcare, for instance most laboratory diagnosis are automated now, you just put in a blood sample, the machine does the rest and repeatedly, consistently does it well, and can do large number of samples, that is beyond human capacity within a short time. So, this is to be encouraged but when it comes to robotic surgery, it is clear that robots can operate in a much finer manner, much speeder manner, in a less emotion charge manner than human beings, and they are doing surgeries outside the country now. So, I see that a little bit scary but necessary. I mean, when I realise that even aeroplanes can fly 400 people with robots; not with human beings doing everything, then I realise that it is easier to trust one soul to robots. So,
I think robotic surgery is an emerging market, and that is going to come, even to Nigeria and I think we have men enough with brains to be able to design robots that can start helping in surgeries. E-health is another aspect whereby patients can monitor themselves at home and send the information digitally to a centre, the hospital's computer and then doctors can analyse so many and give advice without the patients having to come to the hospital. This I see as the improvement of the evolution of e-medicine, and I hope that within the next 10 to 15years that will become a module of practise in any hospital you go to. Are there new technologies that are unlocking the power of creative medicine? Yes! One aspect of creative medicine for example, is in vitro fertilization. When you add that to genetics or molecular biology, the options coming may be scary. People talk of designer babies, people talk of selecting the kind of children they want, even therapies using new technologies to reach organs Healthcare Management Review PAGE Volume 15 042
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the world is changing to is putting power within the patient, you run your bank account from your room, and can access the whole world on the internet from your room, and healthcare within your own home environment is probably the next big thing that is going to come and people like ourselves have to be capable of responding to that this is the re-calibration we are looking at.
directly, so for example you have a headache or an infection, you do not need to swallow medicines and have it all over your body before going to the specific area of need. I think tomorrow's medicine involves where you can target an organ, and treat just that part without involving the rest. So, you will have RNA, if you like, denatured viruses that are primed to go only into the place of need; and I see that as a very creative way forward. And so, designer babies and new therapies that are coming are going to unlock the power of creative medicine. Considering your passion for family and finding ways to make that happen, are there technologies that are changing your approach to IVF and delivery of your service? Yes, again, when you talk about designers babies, you are already talking about me and IVF, so it is where the ethics and the religious barriers cut off. Should it be at the level of community or should it be at level of the individuals. So, is the God of your
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conscience going to allow you to behave openly when it comes to science? For example, you have four girls and you are desperate for a boy and technology can say, ok, your next child will be a boy. Is this ethically correct or religiously correct? So, this is the debate period now and I cannot praise the technology without putting that question mark because human being have not evolved to the point of that positivity that anything positive for me goes, we are still scared. What will God say when we die? What does religion pronounce about it? Even though religions books have been for so many years. So, many of these technologies, designer babies, use of eggs from another woman, which is egg donation or sperm donation, use of the womb for 9months to carry somebody else's baby which is surrogacy and even genetic screening of embryos to know, are they sickle cell babies? or are they well? I see that as what is on our finger tips now but who to sell them to, is the community or the individual that determines whether this is legal or not legal, that is where the position of our country is at this point. Healthcare Management Review PAGE Volume 15 043
spare part medicine.
What is the potential for regenerative medicine in Nigeria?
It is in the world and it is based on knowledge of what the stem cells are, so you can bias these stem cells to become whatever you want them to become and it allows you to also treat organs. Your liver is diseased, you have got hepatic stems cells, all you need to do is to inject that into the liver, it starts growing as a liver cell and is able to function and I know if the question is related to Nigeria, it will take some time for this to come but it is the future of medicine. Namely, spare part medicine.
It's a dream at the moment, but when you talk of organ replacement or organ therapy which is the basis of this stem cell and regenerative medicine generally, I will explain that a little bit, for instance, you have somebody whose limbs were destroyed, maybe in a war front, was shot, the leg is battered, he has to be amputated. Can you grow his leg in a horse and amputate that and put back in his leg? What about his kidney? What about ear? What about the eye? What about this and all that and the spare parts of the body? Nigeria is a little bit far from the technology of regenerative medicine now but I am aware it is here.
Secondly, direct therapy for regeneration, like, your kidney is not working and it is diagnosed early, you inject stem cells to regenerate that part of your kidney and of your brain, you may have heard of people with Parkinson's disease, where part of your brain is fibrosed, you can inject brain stem cells into their brain and that part starts working again and the would not be like Mohammed Ali, etc… The other aspects been that, you can use drugs to cure infections or cancer cells within any specific spot that you want without subjecting the whole human being to the effect of such drug, whether antibiotics or anticancer
So, the battle is between scientific opportunities, ethical and religious barriers, I don't know when they will meet up, but I think they are all bouncing and going back at the moment and leaving the individuals to worry. As saying: when two elephants fight, it's the grass that suffers. That's the situation now.
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Now it is universal medicine, not western medicine.
agents. Again, this is, you can say its today's world in some centres but it is tomorrow's world in a place like Nigeria. What is the economic advantage? Well, the truth of it is, it returns the person as an economic index quickly to the economy of the society, so he loses fewer man-hours. And you know man-hours are signiďŹ cant to economic development. Secondly, anybody who wants to make an investment in medicine now, should start looking at e-medicine
and the molecular biology of medicine and stem cell medicine, that is the way to go. And any country that has relative advantage in this aspect will be medical economic power. So I have looked at it from the individual level of the economy that the brains behind the economy, are freer ultimately to deliver to the economy and macro-economic level, were by, I think those who lead in this aspect of new medicine, Universal medicine, it's not western medicine now, universal medicine those are the ones that will be receiving the medical tourist of tomorrow to boost their economies.
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Anybody who wants to make an investment in medicine now, should start looking at emedicine and the molecular biology of medicine and stem cell medicine, that is the way to go. And any country that has relative advantage in this aspect, will be medical economic power
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Competency M ove m e n t Doing more with less
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Large healthcare institutions may be the most complex in human history and even small healthcare organizations are barely manageable.
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Peter Drucker Some time has passed since Drucker's observation, but the complexity of healthcare organizations, along with the demands on managers and leaders, has not diminished in any way. Today, executives in all healthcare settings must navigate a landscape influenced by complex social and political forces, including, persistent shortages of health professionals, endless requirements to use performance and safety indicators, and prevailing calls for transparency. Further, managers and leaders are expected to do more with less.
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Today's healthcare executives and leaders must have management talent sophisticated enough to match the increased complexity of the healthcare environment. Executives are expected to demonstrate measurable outcomes and effectiveness and to practice evidence-based management.
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Society appears to be sending a clear, overarching message to the nation's hospitals: Take care of more people who have growing expectations and more complex medical needs while providing increasingly sophisticated care with relatively fewer resources.
Don Seymour,
The questions now become.
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Have mid- and senior-level managers been keeping pace with changing demands? Are healthcare academic programs attracting sufficient numbers of students' and adequately preparing them to operate effectively in this dynamic environment?
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Vscan
V
RE ERSE
A SHIFT IN THE CENTRE OF GRAVITY Now, more than ever, success in developing countries is a prerequisite for continued vitality in developed ones Healthcare Management Review PAGE Volume 15 048
Ultrasonic Device
Heart Failure Monitoring Device
I N N O VAT I O N
A
reverse innovation, very simply, is any innovation likely to be adopted rst in the developing world. Increasingly we see companies developing products in countries like China and India and then distribute them globally.
The fundamental driver of reverse innovation is the income gap that exists between emerging markets and the developed countries. There is no way to design a product for the American mass market and then simply adapt it for the Chinese or Indian mass market. Buyers in poor countries demand solutions on an entirely different price-performance curve. They demand new, high-tech solutions that deliver ultra-low costs and “good enough” quality. Reverse innovation is not a “nice to have” boost to revenue growth rates. We believe it will power the future — not just in poor countries, but everywhere. Many tremendous rich-world business opportunities will arise rst in poor countries. To compete, global corporations must be just as nimble innovating abroad as they are at home.
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REVERSE
Innovation I N T E R V I E W Vijay Govindarajan is the Earl C. Daum 1924 Professor of International Business at Dartmouth's Tuck School of Business and Director of its Centre for Global Leadership. Recently, he took a leave and joined General Electric as Professor in Residence and Chief Innovation Consultant. He talks with Stuart Crainer about his 18-month experience at GE and about his concept of reverse innovation and its implications for multinational companies.
You just wrote an article for Harvard Business Review with Jeffrey Immelt, the CEO of General Electric (GE), and your associate, Chris Trimble. What was it about? Historically, global companies innovated in their home markets, the developed world, and took those products into developing countries. We wrote about “reverse innovation”, which is just doing the opposite — innovating in emerging markets and then bringing those innovations back into developed countries. That's the opposite of “glocalization” (a hybrid word formed by merging global with localization), the big idea in the 1990s, which has been defined as “thinking globally and acting locally”. Did glocalization stop working?
The reason that glocalization worked historically is that American companies were taking their products into Europe and Japan (where the customers were similar to US customers). That approach does not work in emerging markets because the whole market structure and the customer problems are so fundamentally different. For example, just take the GDP per capita in two countries, the US and India; there is no product in the US, where the mass market per capita is $50,000, that can be adapted and sold in India, where the mass market per capita is $800. Can you illustrate that point? An interesting example is GE's ultrasound machine. In the US, the ultrasound machine looks like an appliance. It's huge, it's bulky, it costs anywhere from $100,000 to $350,000, and it can do very complicated applications. But 60 per cent of India, Healthcare Management Review PAGE Volume 15 050
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I believe that in the next 25 years the biggest growth opportunity for multinationals will be customers in poor countries
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for example, consists of poor rural areas where there are no hospitals. So, patients can't go to the hospital; the hospital has to come to them. That means you can't use those bulky machines; they must be portable. And again, customer affordability is different as well, so the charges people pay in the US for an ultrasound would be unthinkable in rural India. And this led to reverse innovation? In short, GE created a portable low-cost ultrasound machine, somewhere in the neighbourhood of $15,000, a fraction of the cost of the bulky US machines. And that has opened up a huge market in China and India. Now that same portable ultrasound machine is now coming into the US and creating new applications. This is a great example of reverse innovation. Might this provide GE a chance to grow its business in India as well? Most multinational companies, such as GE, have tried to sell their US products in poorer countries such as India and China; but, again, there was a serious mismatch in possible applications and pricing. That means they were capturing only one per cent of the opportunity in those countries. But, going forward, those countries are going to represent a huge growth opportunity. In fact, I believe that in the next 25 years the biggest growth opportunity for multinationals will be customers in poor countries.
Vijay Govindarajan
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The biggest change for American or European multinationals will be to shift the centre of gravity to where the innovation will take place
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Which is why reverse innovation is important to GE and similar companies. This represents a lot of big changes going forward. For example, where will companies be doing their research and development in the future? The biggest change for American or European multinationals will be to shift the centre of gravity to where the innovation will take place. That means it is an organizational challenge. You have to put the resources where the opportunities are. That means you have to localize product development, you have to localize sourcing, you have to localize strategic marketing capability. This probably represents the biggest required shift in mindset for the leaders of multinationals. How long has GE been practising reverse innovation? It's a relatively new concept. I would say it has caught on within the last five years. While India and China opened up their borders in the last 15 years, it's really in the last five years that we have seen Western companies developing products based on what emerging markets need, want and can pay for.
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Innovation is about commercializing creativity. I don't sense that every major corporation is moving in this direction. What's holding them back? Probably the biggest problem of reverse innovation being adopted in large companies is the companies' historical success. Glocalization, taking global products and selling them with some adaptation in local markets, requires a fundamentally different organizational architecture; and the more you succeed in (and dedicate most of your corporate resources to) glocalization, the more you are going to find it difficult to do a good job in reverse innovation. That's probably the biggest bottleneck, historical success. Companies will move in this direction as more success stories evolve, such as the portable low-cost ultrasound machine. You have a unique role inside a modern corporation, professor in residence. How did that happen? About 10 years ago, I gave the keynote address at a conference at which Susan Peters, the Chief Learning Officer of GE, was also a speaker. I really enjoyed her talk, so I congratulated her on it. She, in turn, asked me what kinds of things I work on, and I told her about my work on reverse innovation. About five years later, I met Immelt when he gave the commencement speech at Dartmouth College, where I have been on the faculty of its Tuck School of Business for some time. I had a half-hour meeting with him, during which I told him about my work in innovation. So, when Immelt and Peters were talking about bringing in an academic to push their thinking, my name came up. It was kind of a series of fortunate accidents, and I think very few academics get this kind of an opportunity. You have been named to each Thinkers 50 list since 2005, including the one just announced in October 2009. What are your thoughts about that achievement? It's obviously a great honour, but also a very
humbling experience, because whenever you are put on a list like that, people think you know a lot. In fact, one of the things I have found is that the only way you can be at the cutting edge as a thinker is if you are humble; and only humble people know how to learn, because they know they don't know a lot. So, in some sense it's an honour, but it's also a feeling that I have a lot more to explore and learn. And you probably explored and learned a lot writing your next book, Great Idea, What's Next? The big idea behind Great Idea, What's Next is that most companies don't lack ideas. What happens is they mistake innovation for creativity. Innovation has little to do with how creative you are. Innovation is about commercializing creativity. As Thomas Edison, the great innovator, pointed out, innovation is one per cent inspiration and 99 per cent perspiration. Inspiration and creativity are what people get wrapped up in (and there are a lot of ideas in companies!), but the 99 per cent perspiration is what they forget. So this book is about that critical 99 per cent. How do you take an idea, an innovative idea, and then make it into a successful commercial business?
Stuart
Crainer
Stuart Crainer is a British management journalist and business theorist, and adjunct professor at IE Business School, known for his work on the history and state of the art of management theory. Healthcare Management Review PAGE Volume 15 052
ADJACENT POSSIBLE As technology expands the possibility space, It expands the chance that someone can find an outlet for their personal trait
“On a certain level, change is being driven by a fundamental property of technology: the fact that it expands into what theoretical biologist Stuart Kauffman calls “the adjacent possible”. Before the invention of the wheel, the cart, the carriage, the automobile, the wheelbarrow, the roller skate, and a million other offshoots of circularity were not imaginable. They existed in a realm that was off-limits until the wheel was discovered, but once discovered, these pathways became clear. This is the adjacent possible. It is the long list of first-order possibilities that open whenever a new discovery is made. The strange and beautiful truth about the adjacent possible is that its boundaries grow as you explore them. Each new combination opens up the possibility of other new combinations. Stuart Kauffman (A Biologist) Healthcare Management Review PAGE Volume 15 053
Reverse Innovation C a s e S t u d y :
Adapted from
Knowledge @ Wharton
I
n May 2009, General Electric announced that over the next six years it would spend $3 billion to create at least 100 health-care innovations that would substantially lower costs, increase access, and improve quality. Two products it highlighted at the time - a $1,000 handheld electrocardiogram device and a portable, PC-based ultrasound machine that sells for as little as $15,000 - are revolutionary, and not just because of their small size and low price. They're also extraordinary because they originally were developed for markets in emerging economies (the ECG device for rural India and the ultrasound machine for rural China) and are now being sold in the United States, where they're pioneering new uses for such machines. Healthcare Management Review PAGE Volume 15 054
Why was reverse innovation impor tant to GE-Healthcare Strategy for Growth?
We call the process used to develop the two machines and take them global, reverse innovation, because it's the opposite of the glocalization approach that many industrial-goods manufacturers based in rich countries have employed for decades. With glocalization, companies develop great products at home and then distribute them worldwide, with some adaptations to local conditions. It allows multinationals to make the optimal trade-off between the global scale so crucial to minimizing costs and the local customization required to maximize market share. Glocalization worked fine in an era when rich countries accounted for the vast majority of the market and other countries didn't offer much opportunity. But those days are over—thanks to the rapid development of populous countries like China and India and the slowing growth of wealthy nations. GE badly needs innovations like the low-cost ECG and ultrasound machines, not only to expand beyond high-end segments in places like China and India but also to preempt local companies in those countries—the emerging giants—from creating similar products and then using them to disrupt GE in rich countries. To put it bluntly: If GE's businesses
are to survive and prosper in the next decade, they must become as adept at reverse innovation as they are at glocalization. Success in developing countries is a prerequisite for continued vitality in developing one. The problem is that there are deep conflicts between glocalization and reverse innovation. And the company can't simply replace the first with the second, because glocalization will continue to
To be honest, the company also is embracing reverse innovation for defensive reasons. If GE doesn't come up with innovations in poor countries and take them global, new competitors from the developing world—like Mindray, Suzlon, Goldwind, and Haier—will.
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GLOCALIZATION ...taking global products and selling them with some adaptation in local markets, requires a fundamentally different organizational architecture dominate strategy for the foreseeable future. The two models need to do more than coexist; they need to cooperate. This is a heck of a lot easier said than done since the centralized, product-focused structures and practices that have made multinationals so successful at glocalization actually get in the way of reverse innovation, which requires a decentralized, local-market focus. Glocalization is so dominant today because it has delivered. Largely because of glocalization, GE's revenues outside the United States soared from $4.8 billion, or 19% of total revenues, in 1980, to $97 billion, or more than half of the total, in 2008. The model came to prominence when opportunities in today's emerging markets were pretty limited—when their economies had yet to take off and their middle or low-end customer segments didn't exist. Therefore, it made sense for multinational manufacturers to simply offer them modifications of products for developed countries. Initially, GE, like other multinationals, was satisfied with the 15% to 20% growth rates its businesses enjoyed in developing countries, thanks to glocalization. Then in September 2001 one of the coauthors of this piece, Jeff Immelt, who had just become GE's CEO, set a goal: to greatly accelerate organic growth at the company and become less dependent on acquisitions. This made people question many things that had been taken for granted, including the glocalization strategy, which limited the company to skimming the top of emerging markets. A rigorous analysis of GE's health-care, powergeneration, and power-distribution businesses showed that if they took full advantage of opportunities that glocalization had ignored in heavily populated places like China and India, they could grow two to three times faster there. But to do that, they'd have to develop innovative new products that met the specific needs and budgets of customers in those markets. That realization, in turn, led GE executives to question two core tenets of glocalization:
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What are the core tenets of Glocalization?
Assumption 1: Emerging economies will largely evolve in the same way that wealthy economies did. The reality is, developing countries aren't following the same path and could actually jump ahead of developed countries because of their greater willingness to adopt breakthrough innovations. With far smaller per capita incomes, developing countries are more than happy with high-tech solutions that deliver decent performance at an ultralow cost—a 50% solution at a 15% price. And they lack many of the legacy infrastructures of the developed world, which were built when conditions were very different. They need communications, energy, and transportation products that address today's challenges and opportunities, such as unpredictable oil prices and ubiquitous wireless technologies. Finally, because of their huge populations, sustainability problems are especially urgent for countries like China and India. Because of this, they're likely to tackle many environmental issues years or even decades before the developed world. All this isn't theory. It's already happening. Emerging markets are becoming centers of innovation in fields like low-cost health-care devices, carbon sequestration, solar and wind power, biofuels, distributed power generation, batteries, water desalination, microfinance, electric cars, and even ultra-low-cost homes.
Assumption 2 Products that address developing countries' special needs can't be sold in developed countries because they're not good enough to compete there. The reality here is, these products can create brandnew markets in the developed world—by establishing dramatically lower price points or pioneering new applications. Consider GE's health-care business in the United States. It used to make most of its money on premium computed tomography (CT) and magnetic resonance (MR) imaging machines. But to succeed in the era of broader access and reduced reimbursement that President Obama hopes to bring about, the business will probably need to increase by 50% the number of products it offers at lower price points. And that doesn't mean just cheaper versions of high-tech products like imaging machines. The company also must create more offerings like the heated bassinet it developed for India, which has great potential in U.S. inner cities, where infant deaths related to the cold remain high. And let's not forget that technology often can be improved until it satisfies more demanding customers. The compact ultrasound, which can now handle imaging applications that previously required a conventional machine, is one example. Healthcare Management Review PAGE Volume 15 057
Homegrown
MODEL To develop that new organizational form, GE did what it has always done: learn from other companies' experiences but also try to find an internal group that somehow had managed to overcome the hurdles and achieve success. During their annual strategy review, the company's leaders spotted one in the ultrasound unit of GE Healthcare. GE Healthcare's primary business is high-end medical-imaging equipment. By the late 1980s it had b e c o m e c l e a r t h a t a n e w technology—ultrasound—had a bright future. Ultrasound machines, like the other imaging devices, were typically found in sophisticated imaging centers in hospitals. While they delivered lower quality than CT or MR scanners, they did so at much lower cost. The company aimed to be number one in ultrasound. Over the next decade, GE Healthcare expanded its presence in the market. It built an R&D facility for developing new ultrasound products near its headquarters, in Milwaukee, and made acquisitions and entered into joint ventures around the world. It
competed in all three of the primary market segments—obstetrics, cardiology, and general radiology—by launching premium products that employed cutting-edge technologies. By 2000, GE Healthcare had established solid market positions in rich countries around the world. The results in developing countries, by contrast, were disappointing. By 2000, with the help of a joint venture partner in China, GE saw the problem: In wealthy countries performance mattered most, followed by features; in China price mattered most, followed by portability and ease of use. The priorities weren't the same because the healthcare infrastructure of China was so different from that of rich countries. More than 90% of China's population relied (and still relies) on poorly funded, low-tech hospitals or basic clinics in rural villages. These facilities had no sophisticated imaging centers, and transportation to urban hospitals was difficult, especially for the sick. Patients couldn't come to the ultrasound machines; the ultrasound machines, therefore, had to go to the patients. Healthcare Management Review PAGE Volume 15 058
In developed economies, performance mattered most, followed by features; in developing economies, price mattered most, followed by portability and ease of use
More than 90% of China's population still relies on poorly funded, low-tech hospitals or basic clinics in rural villages. There was no way that GE could meet that need by simply scaling down, removing features from, or otherwise adapting its existing ultrasound machines, which were large, bulky, expensive, and complex. It needed a revolutionary product. In 2002, the company launched its first compact ultrasound, which combined a regular laptop computer with sophisticated software. It sold for as low as $30,000. In late 2007, GE introduced a model that sold for as low as $15,000, less than 15% of the cost of GE's high-end ultrasound machines. Of course, its performance was not as high, but it was nonetheless a hit in rural clinics, where doctors used it for simple applications, such as spotting enlarged livers and gallbladders and stomach irregularities. The software-centric design also made it easy to adjust the machine—for example, to improve the interfaces—after observing how doctors worked with it. Today the portable machine is the growth
engine of GE's ultrasound business in China. Even more exciting, the innovation has generated dramatic growth in the developed world by pioneering new applications where portability is critical or space is constrained, such as at accident sites, where the compacts are used to diagnose problems like pericardial effusions (fluid around the heart); in emergency rooms, where they are employed to identify conditions such as ectopic pregnancies; and in operating rooms, where they aid anesthesiologists in placing needles and catheters. Six years after their launch, portable ultrasounds were a $278 million global product line for GE, one that was growing at 50% to 60% a year before the worldwide recession hit. Someday every general practitioner may carry both a stethoscope and a compact ultrasound device embedded in his or her PDA.
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Prof A. O Emeribe,
Registrar/CEO, MLSCN- Nigeria.
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INTERVIEW
Prof A. O Emeribe
& the Future of Medicine Prof. Emeribe bears his mind on the Future of Medicine and Medical Laboratory Technologies that are pushing the boundaries and challenging established criteria
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The content of healthcare delivery seems quite different today than, say 20years ago. The healthcare delivery models of yesterday are inadequate to satisfy growing industry and consumer expectations.
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My understanding of lab medicine concept is that a problem identified is half solved. Using laboratory diagnosis to guide clinical decisions. Elimination of trial and error in care and management of diseases. Hence it is the bedrock of modern healthcare as without the laboratory, medicine is blind.
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What type of healthcare delivery model will you advocate for the future and why? In a more concise way, I will advocate a model of preventive health measure where the health priorities will dwell more on preventive health care and wellness based on research findings and less on of the diagnostics and cure model being practiced. The preventive health and fitness model is all about advocating and disseminating the need to live healthy through health education (informed by research), high moral habit and attention to physical and mental exercises, improved sanitation, environmental health, public health programs such as immunization, etc. It means more efficient and effective health care driven by the populace who take greater responsibility for their own health. This will encourage Nigerians to live healthy, free from narcotics and environmental hazards, selfmedications and be physically fit, which will culminate in preventive health than curative, free bed spaces in the hospitals and less pressure on the demand for medical care as majority of Nigerians will only visit hospitals on essential demands like delivery, accident and routine checks. What new medical laboratory technologies are pushing boundaries and challenging established criteria?
Ÿ Nanotechnology: The integration of
nanomaterials with science has led to the development of diagnostic devices, analytical tools, etc and in the future advocated for the care of patients. Ÿ
Regenerative medicine : A branch of translational research in tissue engineering and molecular biology that deals with the process of replacing, engineering or regenerating human cells, tissues or organs to restore or establish normal function.
What is the concept of laboratory medicine? Generally, the concept of the laboratory medicine as defined by MLSCN ACT 11, 2003 LFN: My understanding of lab medicine concept is that a problem identified is half solved. Using laboratory diagnosis to guide clinical decisions. Elimination of trial and error in care and management of diseases. Hence it is the bedrock of modern healthcare as without the laboratory, medicine is blind. a) The practice involving the analysis of human or animal tissues, body fluids, excretions, production of biologicals, design and fabrication of equipment for the purpose of medical laboratory diagnosis, treatment and research. b) In essence, medical laboratory science helps in identifying risks for developing disease, detecting Healthcare Management Review PAGE Volume 15 062
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Without the laboratory, medicine is blind.
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disease early, planning disease management strategies, selecting safe and effective treatment, monitoring treatment response, pinpointing threats to patient safety and public health, protecting the blood supply and transplant recipients from harmful pathogens, and testing for drugs of abuse to support clinical care and to ensure public safety. d) Includes medical microbiology, clinical chemistry, chemical pathology, haematology, blood transfusion science, virology, histopathology, histochemistry, immunology, cytogenetics, exfoliative cytology, parasitology, forensic science, molecular biology, laboratory management; or any other related subject as may be approved by the Council.
to flourish in a developing country like Nigeria because: Ÿ
Opportunity to improve health care for the more than two-thirds of the world's population who live in Nigeria and other developing countries
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Enhanced management of non-communicable diseases whose prolonged and costly care draws significant resources away from basic priorities
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Chronic diseases, the primary targets of regenerative medicine, affect people at a younger age in developing than developed countries.
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The economy in such countries is developing and can be modified to accommodate associated policies and demand if the zeal is there.
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Social support; there is less legal tussle and general acceptance.
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Adequate human resources, if trained can aid the implementation of this process
What is the potential of regenerative medicine in developing economies like Nigeria? Regenerative medicine is a branch of translational research in tissue engineering and molecular biology that deals with the process of replacing, engineering or regenerating human cells, tissues or organs to restore or establish normal which function is bound
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What new organizational architecture will unlock the power of creative medicine? Ÿ
The new organizational architecture needed to unlock the power of creative medicine includes
:Emerging structure Ÿ Established structure Ÿ Network structure. Ÿ
Ÿ
Emerging Organizational Support Structure
This focuses on bringing teams together so as to identify opportunities, estimate the impact of change (including workforce demographics, new technologies, and regulatory change) and construct innovations in all three components of innovative process; innovation, creativity, and the environment. Mostly designed to build, develop enhanced skills in problem solving and end-user innovation by framing question as “What is the job to be done?” Asking fundamental questions and reminding us of the underlying objective that needs to be met, thus allowing for greater creativity, for re-exploration of the issues and for opening the door for disruptive innovation. (eg Center for Innovation and Care Delivery). Ÿ
The healthcare sector must completely rethink staffing based on technology What is your position? The world as well as the healthcare sector is highly dynamic in technology and this requires upwardly motivated and highly trained professionals. This we are keying into by the use of technology like iHRIS for our health workforce forecast – where we are completely going computerized; the quota for school enrolment, the proposed trained personnel and the active personnel are all imputed and controlled, leading to the right number, size and impressive inventory of skills needed for the maintenance of quality health laboratory services Ÿ
How will emerging technological trend affect medical laboratory scientists?
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Emerging technological trend will affect medical laboratory scientists in areas like: Genetics and genomics Less invasive and more accurate tools for diagnosis and treatment 3-D printing Robotics Biometrics - security of patient data, e.g. Assess to insurance scheme. Electronic health records Computerized laboratory request and result entry Bioinformatics
Established Organizational Support Structure
This improves health care by bringing scientists, engineers, and clinicians together to catalyze the development of innovative technology. It supports the translational research of multidisciplinary teams that are working with medical devices and clinical technology system applications and that have the goal of solving medical problems through innovative technology. Eg The Center for the Integration of Medicine and Innovative Technology Ÿ
discussion on the methods of “design thinking,” ignite the transfer of ideas and provide opportunities for inter-organizational collaboration. These are aimed at building skills in design thinking, graphic facilitation, ethnography, prototyping, group consulting, smart networking and open-space facilitation
.Network structure / Innovation Community:
Conveyance of innovative healthcare organizations to share the joys and pains of innovation, to foster
Ÿ Ÿ Ÿ Ÿ Ÿ Ÿ Ÿ
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Ÿ Ÿ Ÿ Ÿ Ÿ
Computational biology Functional imaging tools using biosensors and biomarkers Transformation and transient expression technologies Nanotechnologies Turnaround time
Do the priorities of your organization change to match what is happening externally? Yes. What is your prospective on public private partnership in healthcare considering the social nature of the healthcare industry? In the words of Dr G. C Okara, there is no gainsaying that 21st century healthcare practice is technology and equipment driven. There is a critical lack of this modern equipment in our healthcare facilities. This is more so in diagnostic and medical laboratory services. The concept and practice of PPP in medical laboratory services should key into partnership arrangements with equipment manufacturers and manufacturers' representatives in Nigeria for wet lease agreement as it obtains abroad. This enables manufacturers to deposit their equipment in public health facilities with guarantee of purchase of reagents and consumables for such equipment by the facilities over a sustained period of time. This ensures that the manufacturer or their agents have a sustained market for their products which guarantees profitability over time. It also ensures constant service and maintenance backup for the equipment by the manufacturers. When newer and upgrade models of the equipment are introduced, the manufacturer will usually replace
the old one through a trade-in arrangement. This type of partnership arrangement will avoid escalation of the cost of diagnostic tests and investigations which often put services out of the reach of most patients and clients.
The current practice of commercialization and outsourcing of core health services to shylock business outfits in the name of PPP is an aberration and indeed betrays the abysmal failure of management of these hospitals. In modern management principles and practice, ancillar y ser vices are outsourced in order to maximize effort on the core business of an organization. Any attempt to outsource the core business means there is an abysmal failure of management or what may be termed the obituary announcement of the business. Core versus non-core business exists in healthcare practice. Core business includes clinics, nursing, laboratory and pharmaceutical services. You also have non-core or ancillary business.
What is the way forward? The way forward is to vigorously pursue the implementation of the approved Nigeria National Medical Laboratory Services Policy and institutionalize partnership with known and credible equipment manufacturers and their representatives to promote wet lease of equipment in our health facilities in Nigeria.
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Dr. Prosper I. Igboeli MD, FACOG, FWACS, FICS
M & M Hospital Bioheart Regenerative Medicine Centre (the First Stem Cell Expansion Centre In Nigeria)
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To d a y w e h a v e b e t t e r understanding of how the body utilizes the Adult Mesenchymal Stem Cells to repair its own damaged tissues and organs.
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EVOLUTION OF STEM CELLS AND THEIR APPLICATION IN MODERN MEDICAL THERAPEUTICS IN NIGERIA.
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tem cell therapy has been found to be beneďŹ cial in managing several disease states. Since 1988, scientists and investigators have uncovered many sources and dierent types of stem cells in the human body. In the early stages of stem cell research and development, many scientists were using discarded and donated embryos for their studies. They cloned monkey, pig, gaur, cattle, cat, rat, etc. These generated a lot of public fury and debate as they considered embryos as potential humans and their use unethical. Many countries then banned embr yonic stem cell research based on ethical consideration.. Healthcare Management Review PAGE Volume 15 067
THERE ARE TODAY EMBRYONIC, ADULT AND INDUCED PLURIPOTENT STEM CELLS. Virtually all tissues in the human body possess stem cell capabilities. The most notable are stem cells derived from adipose tissue, bone marrow, muscle, teeth etc. None of these sources of stem cells has ethical issues or concerns. They have found acceptability in many countries. Disease states in which stem cell therapy have been found to be beneficial include but not limited to management of Alopecia, auto immune diseases, cancer, congestive heart failure, diabetes, erectile dysfunction, degenerative joint diseases, orthopaedic conditions e.g. arthritis, spinal cord injuries, stroke among many others. Because of the long term nature of many of the human conditions needing stem cell therapy, it is always beneficial to harvest the stem cells, use some at the point of patient presentation, and process the rest through further cell culture, cell expansion through several passages
and cryopreserved in vials stored in sub zero temperatures for future use by the patient. Every day, Bioheaart remains laserfocused on delivering scientific advancements throughout the world and developing a partnership in Nigeria is a testament to that mission,” said Kristin Comella, Bioheart's Chief Scientific Officer. “We have many patients in Nigeria that can benefit from Bioheart therapies and the ability to culture expand and bank cells locally will provide many advantages.” Bioheart's partnership will establish a critical relationship with the Nigerian government and the joint venture will work closely with the Ministry of Health to make Bioheart protocols part of the standard of care for patients in Nigeria. Bioheart will provide the necessary training and expertise to transfer Bioheart therapies to the new facility.
Bioheart, Inc. (BHRT), a biotechnology company focused on the discovery, development and commercial-ization of autologous cell therapies for the treatment of degenerative diseases, has entered into a joint venture with Dr. Prosper Igboeli of Nigeria. Under this new agreement, the facilities in Nigeria will be expanded to provide cell culture expansion and cryopreservation to local patients. Bioheart can multiply and preserve an individual's cells in sub-zero temperatures for future treatments as required. Healthcare Management Review PAGE Volume 15 068
Dr Bazuaye Godwin Nosakhare
& the Genotype Change Technology in Nigeria
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Sickle cell disease is the most prevalent Hemaglobinopathy in Nigeria. With Allogeneic HSCT from a HLA matched sibling we have successfully transplanted a 7 year old Sickle Cell Anaemia . With the assistance of government and improved Health Insurance Policy we could make HSCT available to many Nigerians who have both malignant and non-malignant disorders
Dr Bazuaye Godwin Nosakhare Professor of Hematology and stem cell transplantation. M.B.B.S (Benin), FMC(Path),CERT. Stem cell transplantation(Switzerland)
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ust as some hematologist in Nigeria had passion to perform stem cell transplantation for Nigerians I was moved by sufferers of Sickle cell disease and those with hematological malignancies dying daily to seek for a place outside the country to specialize in Stem cell transplantation. I wrote several letters and a centre in USA asked me to speak to a Nigerian hematologist who is part of their transplant team and when I asked why he is not willing to come to Nigeria, he said it was impossible to do such a procedure in Nigeria .I did not get a place for training until 2008 when I travelled for a holiday in Geneva but 2 weeks before my trip, the secretary to EBMT (Mrs Baldameroh Helen) was a guest speaker at our Society 2008 annual conference at Ile Ife with the theme on Stem cell transplantation. While I was in Swiss, I visited Basel Hospital Switzerland at the invitation of Helen who introduced me to Prof Alois Gratwohl, the head of stem cell transplant centre who agreed to train me for one year.I demanded that some nurses and lab scientist be trained to have a complete team. I started my training in June 2009 to July 2010 while two nurses and a lab Scientist was trained for 3 months. We all returned back in July 2010 and started in training of other personnel in UBTH. We got all the support we needed to start the program from the board and management of UBTH. In 2011 we had restructured a section of the public private partnership building to have a 4 isolation room, a kitchen, a laundry, a conference room, a consulting room, a pharmacy and a changing room. However only one isolation room was fully furnished and we admitted our ďŹ rst patient in september 2011.The compatibility test (HLA) was done in Switzerland who carried out free HLA typing for our centre.
A hematologist from Swiss joined us and the ďŹ rst successful stem cell transplant in sub-sahara black Africa was done in 2011.We did not have blood product irradiation facility in UBTH so we had to put inverter batteries in an ambulance connected to a platelet agitator and a small refrigerator for the packed cells. We drove to EKO Hospital that had the only functional linear accelerator to irradiate our blood products. We had another patient in 2012 and the third in 2013.We could only perform one transplant a year because we have only one isolation room.Two of the three patient had a cure with their genotype changed from SS to AA while the third patient developed high persistent fetal hemoglobin and clinically stable. All patients are alive and clinically stable. We have not been able to do more transplant due to lack of support from the federal Government, high cost of transplantation which is 5million Naira (though the cheapest in the world but still above the income of the average Nigerian). Also frequent strike actions by health personnel in Nigeria has a negative impact on ability to perform continuous stem cell transplantation. Stem cell transplantation is a cure for several other diseases like hematological malignancy, Bone marrow failure etc which is yet to commence in Nigeria. Also this can also be a source of foreign exchange for Nigeria and a centre of academic excellence if we have an international centre. The federal Government and NGOs must invest in the transplant business to assist the over 170million Nigerians.
We could only perform one transplant a year because we have only one isolation room. We have not been able to do more transplant due to lack of support from the federal Government, high cost of transplantation which is 5million Naira (though the cheapest in the world but still above the income of the average Nigerian). Dr Bazuaye Godwin Nosakhare Healthcare Management Review PAGE Volume 15 071
in
HEALTHCARE
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3D printing or additive manufacturing is a process of making three dimensional solid objects from a digital file. The creation of a 3D printed object is achieved using additive processes. In an additive process an object is created by laying down successive layers of material until the entire object is created. Each of these
layers can be seen as a thinly sliced horizontal crosssection of the eventual object.
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WHAT IS 3D PRINTING?
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raditionally, 3D printers have worked by additive manufacturing, a process in which a machine lays materials, such as plastic or glass, to create an object. This kind of printing is common to places like Boeing, Honeywell and General Electric, where many parts are manufactured with 3D printing. In the world of healthcare, 3D printing is already used to create dental implants, hearing aids, contact lenses and prosthesis that are tailored to the individual. Creating customized medical devices offers many advantages for the patient. The perfect fit of a prosthetic limb, for example, makes it much more comfortable to wear and reduces the risk of infection
or other complications. Replacing a knee or hip with a device that is customized for that particular patient can cut down on operating time and expenses, promote faster healing and possibly lead to a more comfortable, longer-lasting joint. There is also a psychological aspect to the use of 3D printed parts. “Because 3D printed designs can be unique and cool, things like prosthesis that used to be something to hide are now a fashion statement,” said Sarah Boisvert, the chief 3D printing officer at Potomac Photonics, Inc. “Bespoke and 3D Systems are demonstrating this today with customers matching their artificial legs to their outfits. The social ramifications are even more powerful.
EARLY SUCCESSES WITH 3D PRINTING
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he victories for 3D printing are already piling up. Top medical facilities like the Mayo Clinic are now offering flexible replacement knee joints printed with nylon, which mimic bones and cartilage. Cornell University is busy printing experimental heart valves and bone implants, while researchers at Wake Forest University have been successful in creating kidney cells. The reach of 3D printing has improved and even saved lives. In 2011, a man in the UK who lost half his pelvis to bone cancer received a new pelvis created of 3D materials, and is still happy with the results. In 2012, infant Kaiba Gionfriddo made headlines when doctors in Ohio implanted a 3D printed airway splint that allowed him to breathe normally. The child is now a healthy toddler. In March 2014, it was reported that 75 percent of an American patient's skull was replaced by a 3D implant created by Oxford Performance Materials. Made of a biomedical polymer, the artificial skull was created to exact specifications for the patient,
and included surface details that encouraged easy attachment and new cell growth. But the wonders of 3D printing aren't limited to implants. In February 2014, doctors at Kosair Children's Hospital in Louisville, Ky. needed to operate on a small child with multiple heart defects. By printing a 3D version of the child's heart, doctors could study the heart's defects and create a surgical plan before wheeling the child into the operating room. The surgery was a success. Just announced last week, a 22 year old woman's skull was successfully replaced with a 3D-printed implant. Performed by Dr. Bon Verwejj of University Medical Center (UMC) Utrecht, the skull was 3Dmodeled and then printed as a single full piece slotted and secured into place. 3D printing can ensure the components of the skull are an exact fit. Verwejj stated, “this has major advantages, not only cosmetically but also because patients often have better brain function compared with the old method.”
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Transplant without a donor
Organs made from tissue, not plastic or metal, would perform more like those with which we are born.”
THE FUTURE OF 3D PRINTING IN HEALTHCARE As the advantages of 3D printing become clear, many hospitals and physicians are embracing what it can do. In 2013, there was a $1.2 billion market for 3D printing in healthcare; by 2018, that will increase to over $4 billion, according to a study by Visiongain. While much of that booming market might come from the increased use of customized prosthesis and other devices, there are much more ambitious 3D printing uses on the horizon. One of these advances is known as bioprinting, or the ability to print living tissues. The printers make use of “bio-ink,” a blend of living cells. The bioprinter builds a structure from these cells, layer by layer, to create human tissue. Researchers are already testing the technology for use in creating skin grafts, knee cartilage and small heart valves. The next step? Creating organs for the human body.
The next step? Creating organs for the human body.
The ability to create a kidney, pancreas, or heart from a person's own cells with a bioprinter has enormous implications for healthcare, including reducing the lengthy transplant lists, improving the chances of recovery and possibly even controlling or curing chronic diseases, like diabetes. “Printing body parts from cells or tissue is years off as initial results are just in, and we would still have to go through FDA approvals,” Boisvert said. “But the ability to have a perfect match and not have to wait for a donor would save countless lives and is the future of medicine. Organs made from tissue, not plastic or metal, would perform more like those with which we are born.”
3D printing is already making a significant impact, but this is just the tip of the iceberg. Printing organs made from cells is really in the early stages but initial results are promising, I expect this sector to hit the market in ten to twenty years, and then the impact will be huge. Sarah Boisvert Healthcare Management Review PAGE Volume 15 075
Dr. Samuel
Acheilefu
CA N C E R- S E E I N G G LA S S E S
VISIONARY CARE AT SITEMAN CANCER CENTRE
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ancer cells are notoriously difficult to see, even under high-powered magnification. To a surgeon's naked eye, they often are indistinguishable from healthy cells nearby. However, high-tech goggles developed by Washington University researchers at Siteman Cancer Center in St. Louis help surgeons identify malignant cells, making them glow blue when viewed through the eyewear. The wearable technology – so new it's yet unnamed – helps to ensure that no stray tumor cells are left behind. “We're in the early stages of this technology, and more development and testing will be done, but we're certainly encouraged by the potential benefits to patients,” said surgeon Julie Margenthaler, MD, who first used the goggles in February.
The current standard of care requires surgeons to remove the tumor and neighboring tissue. If cancer cells are found in neighboring tissue, a second surgery often is recommended to remove additional tissue that is then checked for the presence of cancer. The glasses could reduce the need for additional surgery and subsequent stress on patients, as well as time and expense. Margenthaler says about 20 to 25 percent of breast cancer patients who have lumps removed require a second surgery because current technology doesn't adequately reveal the extent of the disease during the initial procedure. “Our hope,” she said, “is that this new technology will reduce or eliminate the need of a second surgery.” The technology, developed by Samuel Acheilefu, PhD, and a team of colleagues, incorporates custom Healthcare Management Review PAGE Volume 15 076
video technology, a head-mounted display, and a targeted molecular agent that attached to cancer cells, making them glow when viewed through the glasses. In a study published in the Journal of Biomedical Optics, researchers noted that tumors as small as 1 millimeter in diameter could be detected. Surgeon Ryan Fields, MD, used the glasses when he performed surgery to remove a melanoma from a patient. “A limitation of surgery is that it's not always clear to the naked eye the distinction between tissue and cancerous tissue,” he said. “With the glasses developed by Dr. Achilefu and his team, we can better identify the tissue that must be removed.”
Achilefu, a Washington University professor of biochemistry and molecular biophysics, who is also co-leader of Siteman's Oncologic Imaging Program, is seeking FDA approval for a different molecular agent that specially targets cancer cells and stay in them longer. Achilefu's team includes Washington university engineering professor Victor Gruev, PhD, and Ron Liang, PhD, of the University of Arizona. Washington University graduate students Suman Mondal, Shengkui Gao, and Yang Liu and postdoctoral fellow Nan Zhu also played key roles in the National Cancer Institute-funded research. “This technology has great potential for patients and health-care professionals,” Achilefu said. “Our goal is to make sure no cancer is left behind.” Healthcare Management Review PAGE Volume 15 077
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...as a country, our future healthcare organization has to be technology driven to be able to drive us into the future of our dreams.
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INTERVIEW
DR CHRISTOPHER .U. OTABOR, FWACS, MBBS, FAAOS Consultant Orthopaedics And Trauma Surgeon, Chief Medical Director Alliance Hospital Abuja
Speaks to HMR on the Fundamentals that are transforming the Healthcare system
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A number of factors would transform our healthcare organizations in the future. Chief among these factors is innovation.
...there is definitely a need to bring in fresh ideas and inputs into our healthcare organizations whether in the public or private sector, but more in the public healthcare institutions and regulatory agencies.
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FUNDAMENTALS TRANSFORMING THE HEALTH SYSTEM
What forces will transform our healthcare organization in years to come? A number of factors would transform our healthcare organizations in the future. Chief among these factors is innovation. We cannot do the same things repeatedly and expect a different result. There is definitely a need to bring in fresh ideas and inputs into our healthcare organizations whether in the public or private sector, but more in the public healthcare institutions and regulatory agencies. As a country, our future healthcare organization has to be technology driven to be able to drive us into the future of our dreams. It starts with data. We do not know exactly how many we are, how many are employed or where the people live, how then can we budget effectively for healthcare. I think the national identification system that would capture every Nigerian and keep immigration statistics is key to our healthcare development. We need technology to achieve this.
Leadership: brave and pragmatic leadership would help to transform Nigeria's healthcare climate in the future. Because of the huge challenges that have bedeviled Nigeria's health care system over the years coupled with dwindling finance available to government, successive healthcare leaders have been caught in this vicious cycle of “coasting”. They allow the currents of the status quo to drive same old policies that have not worked. The future healthcare leaders in Nigeria would need to think outside the box and drive social innovations for us to have a transformation. For instance, government sinks a huge sum of money into hospitals. A large chunk of the money is used to settle personnel cost yet service delivery and efficiency is far below pass mark. We need to do an independent audit of the government hospitals and find out what is working and what is not. Government can subsidize cost of healthcare through other means without the wastages in our public healthcare centers. In most countries with thriving health systems, tertiary healthcare is in Healthcare Management Review PAGE Volume 15 079
Healthcare is perhaps the biggest business in the world. In advanced economies, most hospitals are privately owned.
the hands of private healthcare institutions. This helps to ensure efficiency and profitability. The future of tertiary healthcare in Nigeria is in the private sector. Government health institutions have proved not to be the panacea for the tertiary healthcare delivery Nigeria. Recently, there has been a proliferation of public – private partnership initiatives which has produced excellent results. This should be improved upon. How would you recalibrate your leadership for the future? It is about looking into the future to anticipate the challenges that awaits us as a country and then prepare for such challenges. For instance, the level of information technology usage in our health system is still low at the moment, but any forward looking leader would have to think of creating access to this vital tool at the lowest possible cost to impact the largest possible number of health care workers. This singular effort can bring about improved efficiency and help meet international best practice. How will you apply digital technology to improve service deliver? Digital technology has transformed healthcare delivery world over. In Nigeria, the health care industry is just beginning to embrace digital technology. Digital equipments are known to be
faster, more accurate and more efficient than the analogue systems. We now have digital x – ray machines, digital thermometers, digital patient monitors, digital laboratory equipments, e.t.c. Software for hospital management are now available. This reduces patients waiting time, makes medical records easy to retrieve and maintain decorum in the hospital environment. Telemedicine represents a huge untapped resource that is yet to be embraced fully by the Nigerian healthcare system. It makes treatment possible by a far away medical personnel for a patient in remote location. It improves knowledge sharing and training. What are the competences required of healthcare executives, directors and managers to address the current and future needs of the healthcare industry? Present and future industry leaders would require a good understanding of the healthcare environment in Nigeria, they would require a good knowledge of digital technology trend and human resources management skills as well as conflict resolution skills. Public finance management skills would also help in managing the dwindling finances in our public health sector. Healthcare Management Review PAGE Volume 15 080
a combination of massive enrollment into the health insurance scheme and phased privatization of public health institutions is the way to go for our healthcare system. Are we going in the right direction? Yes and No! In many ways, we are going in the right direction in terms of healthcare delivery albeit slowly. For instance, the fact that we have a national health insurance scheme in places is a right step in the right direction, however the enrolment rate of about 6% is too rudimentary to make signiďŹ cant impact on our health system. If we can quickly scale up enrollment to at least 60% in a couple of years, that would capture majority of Nigerians under the scheme. For Nigerians that are not employed, the government is better off paying their capitation under privately run health scheme than putting the money into paying personnel cost of hospitals with low productivity in the name of subventions. The national primary healthcare development agency is doing a good job and should be encouraged to continue. The national health act has carved out a great role for the agency when the act becomes fully operational.
Healthcare is both a social service as well as a business. Healthcare is perhaps the biggest business in the world. In advanced economies, most hospitals are privately owned. This is because government is not a good business person. If the government wishes to render social interventions by reduction or eliminating cost of treatment for the poor, they fund the health insurance of the poor who are at liberty to use the private health centers. Health insurance should be compulsory for all employed. Health insurance is more or less compulsory in some countries. Everyone pay a little when they are well and there is a large pool of funds available to treat the few who would fall ill at any time. If people would not pay from their pockets when they go to the hospital, majority would prefer to be treated in standard private health institutions. So in conclusion, a combination of massive enrollment into the health insurance scheme and phased privatization of public health institutions is the way to go for our healthcare system.
What are your perspective on public private partnership in healthcare considering the social nature of healthcare industry?
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P4
MEDICINE
P-4 stands for “Predictive – Personalized – Preventive- & Participatory” and is where healthcare is heading. Combine cheap, ultra-fast, medicalgrade genome sequencing with massive computing power, and we're enroute to the first two categories: Predictive and Personalized medicine.
- GREAT PETER H. DIAMOND & STEVE KOTLER
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PREDICTIVE – PERSONALIZED – PREVENTIVE - PARTICIPATION
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uring the last decade, sequencing costs have dropped from Craig Venter's historic $100million genome in 2001 for an anticipated $1,000 version of equal accuracy. Companies such as Illumina, Life Technologies, and Halycon Molecular are vying for the trillion-dollar sequencing market. Soon every newborn will have his or her genome sequenced. Genetic profiles will be part of standard patient care. Cancer victims will have their tumors DNA analyzed, with the results linked to a massive data correlation efforts. If done properly, all three efforts will yield a myriad of useful predictions, changing medicine from passive and generic to predictive and personalized. In short, each of us will know what diseases our genes have in store for us. What to do to prevent their onset, and should we become ill, which drugs are most effective for our unique inheritance. But rapid DNA sequencing is only the beginning of today's biotech renaissance. We are also unravelling the molecular basis for disease and taking control of our body's gene expression, which together can create an era of personalized preventive medicine. One example is the potential to cure what the WHO now recognizes as a global epidemic: obesity. The genetic culprit here is the fat insulin reception gene that instructs our body to hold on to every calorie we consume. However, a new technology called RNA interface (RNAi) turns off specific genes by blocking the messenger RNA they produce. When Harvard researchers used RNAi the sheet off the fat insulin receptor in mice, the animals consumed plenty of calories but remained thin and healthy. As an added bonus, they lived almost 20percent longer, obtaining
the same benefit as caloric restriction, without the painful sacrifice of an extreme diet. Participatory medicine is the fourth category of our healthcare future. Powered by technology, each of us is becoming the CEO of our own health. The mobile phone is being transformed into a mission control center where our body's real-time data can be captured, displayed and analyzed, empowering each of us to make important health decision day by day, moment by moment. Personal genomics companies such as 23 and me and Navigenics, meanwhile, allow users to gain a deeper understanding of their genetic makeup and its health implication. But equally important is the effect of our environment and daily choices – which is where a new generation of sensing technology comes into play. Sensors have plummeted in cost, size, and power c o n s u m p t i o n . Ta k i n g a d v a n t a g e o f t h e s e breakthroughs, members of movements such as 'Quantified Self' are increasing self-knowledge through self-tracking. Today they're tracking everything from sleep cycles, to calories burned, to real-time electrocardiogram signals. Very soon, should one choose to go this route, we'll have the ability to measure, record, and evaluate every aspect of our lives: from blood chemistries to our exercise regimen to what we eat, drink, and breathe. Never again will ignorance be a valid excuse for not taking care of ourselves.
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HYPER
CONVERGENCE
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Silos of all description are collapsing ...un-meshable disciplines are becoming meshable
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o n v e r g e n c e i s o n t h e w a y. M o re accurately, convergences. First, the world continues to shrink and converge because of the Internet. Geographic silos collapse. Second, and largely unseen, as “things” shrink from small (micro), to smaller (mano) and smallest (quantum), the less they fit into traditional “disciplines” of engineering and science – chemistry, electronics, mechanical. They're just small and hang together: so small, multinational, and soon controllable, that they don't know and don't care which “department” they are in. The sciences converge. One plus two is resulting in the ability for three to occur. Non-obvious domains of knowledge are marrying up to create Internet of Things solutions; hyper convergence. Silos of all description are collapsing. Heretofore unmeshable disciplines are becoming meshable. In our care, we collide worlds ranging from precision manufacturing to advance conductive materials, nano electronics to UX gamification, medicine to
machining, to present the types of data, information and user experience IoT customers seek. All with an eye to the design element welded in. The world comes together. Look at the coolest products emerging today and think through not only what it took, and as importantly, who it took, to bring them to life. The Internet of Things brings together people, geographies, sciences and technologies as diverse as one could imagine. The old. The new. Centuries old to NIML. You can imagine the meetings! Exciting! Amazing! The Internet of Things Spawns New Organisational Forms With discipline convergence comes organizational evolution. New partnerships forged. The rule of thumb used to be that structure followed strategy. In the IoT structure is strategy! Who sits at your table drives what is served. The ingredient in our orgranisatinal potion dictate taste. That too evolves, companies tiny and titan alike. Healthcare Management Review PAGE Volume 15 085
Creative Destruction OF MEDICINE Our lives have been radically transformed & Creatively destroyed through digital innovation.
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igital innovations have now made it possible for consumers to use portable devices to access their medical information, monitor their vital signs, take tests at home and carry out a wide range of tasks. In his book "The Creative Destruction of Medicine," Eric Topol, a cardiologist, geneticist and researcher, describes how medicine is entering an age of democratization as power shifts from hospitals, doctors and other caregivers to patients, potentially leading to dramatic health care improvements. In the mid-20th century Joseph Schumpeter, the
noted Austrian economist, popularized the term "creative destruction" to denote transformation that accompanies radical innovation. Our lives have been radically transformed through digital innovation. Radically transformed. Creatively destroyed. But the most precious part of our existence – our health – has thus far been largely unaffected, insulated and almost compartmentalized from this digital revolution. How could this be?Medicine is remarkably conservative to the point of being Healthcare Management Review PAGE Volume 15 086
Medicine is about to go through its biggest shakeup in history.
Eric Topol, Author: The Creative Destruction of Medicine.
When you introduce new technology into health care, it is invariably coupled with increased cost. But we have opportunity to turn that model around. —Eric Topol, MD.
properly characterized as sclerotic, even ossified. Beyond the reluctance and resistance of physicians to change, the life science industry (companies that develop and commercialize drugs, devices or diagnostic tests) and government regulatory agencies are in a near-paralyzed state, unable to break out of a broken model determining how their products are developed or commercially approved. But that is about to change. Medicine is about to go through its biggest shakeup in history. For the first time we can digitize humans. We can remotely and continuously monitor each heart beat,
moment-to-moment blood pressure readings, the rate and depth of breathing, body temperature, oxygen concentration in the blood, glucose, brain waves, activity, mood – all the things that make us tick. We can image any part of the body and do a threedimensional reconstruction, eventually leading to the capability of printing an organ. Or, we can use a miniature, handheld, high-resolution imaging device that rapidly captures critical information anywhere, such as the scene of a motor vehicle accident or a person's home in response to a call of distress. We can determine all 6 billion letters ("life codes") of a person's genome sequence. Healthcare Management Review PAGE Volume 15 087
Digital innovations make it possible for consumers to use portable devices to access their medical information, monitor their vital signs and carry out a wide range of tasks
And all of this information about an individual can be assembled from wireless biosensors, genome sequencing or imaging to be readily available, integrated with all the traditional medical data and constantly updated. We now have the technology to digitize a human being in highest definition, in granular detail, and in ways that most people thought would not be possible. This reflects an unprecedented super-convergence. It would not be possible were it not for the maturation of the digital world technologies – the ubiquity of smartphones, bandwidth, pervasive connectivity and social networking. Beyond this, the perfect digital storm includes immense, seemingly unlimited, computing power via cloud server farms, remarkable biosensors, genome sequencing, imaging capabilities and formidable health information systems.
telecommunications convergence, but also a remarkable number of devices all rolled into one gadget: camera, video recorder, GPS, calculator, watch, alarm clock, music player, voice recorder, photo album and library of books – like a pluripotent stem cell. Armed with apps, it carries out diverse functions from flashlight to magnifying glass. Then connect it to a wireless network, and this tiny device is a web surfer, word processor, video player, translator, dictionary, encyclopedia and gateway to the world's knowledge base. And, by the way, it even texts, emails and provides phone service. But now picture this device loaded for medicine, capable of displaying all of one's vital signs in real time, conducting laboratory analyses, sequencing parts of one's genome, or even acquiring ultrasound images of one's heart, abdomen or unborn baby
Eric Topol
Think of the cellphone, which is not only a hub of Healthcare Management Review PAGE Volume 15 088
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Dr. Watson
Come Here I Need You
WATSON'S brain is a massively parallel system composed of a cluster of ninety IBM Power 750 servers. The end product could handle 500 gigabytes of data per second, or the equivalent of 3.6billion books per hour. And that's only the hardware. The bigger breakthrough was the DeepQA software, which allows Watson to “understand” natural language – Watson had to not only comprehend context, slang, metaphors, and puns but also gather evidence, analyze data, and generate hypotheses. So what can we do with a computer like this? Well, a company called Nuance Communications has teamed up with IBM, the University of Maryland Medical School and Columbia University to send Watson to medical school.
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A Super Computer named after IBM's First President – Thomas Watson Sr. DR. WATSON
“Watson has the potential to help doctors reduce the time needed to evaluate and determine the current diagnosis of a patient. He also has the ability to develop personalized treatment options for every patient.”
Dr. Herbert Chase Professor of Clinical Medicine at Columbia University.
“Imagine a supercomputer that cannot only store and collate patient data but also interpret records in a matter of seconds, analyze additional information and research from medical journals, and deliver possible diagnoses and treatments, with the probability of each outcome precisely calculated”. Dr. Eliot Siegel. Professor and Vice Chairman at Maryland's Department of Diagnostic Radiology. Healthcare Management Review PAGE Volume 15 092
ONE IMPORTANT FEATURE OF HEALTHCARE ORGANIZATIONS
An important feature of healthcare organizations. Whether they are governmentowned, independent not-for-profits, or commercial healthcare providers, they all share to some degree a sense of social mission or purpose concerned with the public good (Drucker 2006). The professional values and culture of healthcare are deeply embedded, and most people working in healthcare organizations have both an altruistic belief in the social value of the work they do and a set of more self-interested motivations to do with reward, recognition and advancement. Similarly, healthcare organizations – even commercial, for-profit entities – do some things which do not make sense in business terms, but which reflect their social mission, while at the same time they respond to financial incentives and behave entrepreneurially. When exposed to strong competitive pressures, not-for-profit and commercial for-profit healthcare providers behave fairly similarly, and their social mission may take second place to organizational survival and growth. The challenge, at both the individual and organizational level, is to make proper use of both sets of motivations, and not lose sight of the powerful and pervasive beneficial effects that can result from understanding and playing to the social mission.
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TURF WARS INTERVIEW
How Hospitals Adopt New Technology Sera Grant interview with Gary Pisano and Robert Huckman on how turf wars and learning curves influence new technology adaption in hospitals
In studying the adoption of innovation in hospitals, you note an interesting road block: turf wars. Can you describe how turf wars influence hospital decisions to buy new technology? Have you seen similar turf war issues in other industries? Hospitals are characterized by the presence of multiple groups of highly trained specialists, each of which has its specific technological and clinical
approaches. When multiple specialty groups converge on the treatment of a particular patient population—as is the case with cardiac surgeons and cardiologists—turf wars can emerge. Very often, these turf wars are created because hospitals have already made initial investments in two or more competing technologies, thereby leading to the development of a constituency of physicians around each technology. Healthcare Management Review PAGE Volume 15 094
For example, when angioplasty entered mainstream use in the 1980s, most hospitals that already had cardiac surgery programs felt that they needed to adopt angioplasty to "round out" their portfolio of cardiac services. At the time, this decision did not create much conflict between surgeons and cardiologists, as the two technologies were not great substitutes for each other. As angioplasty's performance improved over time, however, the two technologies became increasingly substitutable and the physician groups associated with each moved into closer competition with each other. Where turf wars do seem to have more of an impact is in how aggressively a hospital supports its initial investment in a given therapeutic area in terms of ongoing financial support for updated technology, marketing to patients, and recruitment of new physicians. These turf wars clearly exist in other industries, though unlike the hospital settings, these battles are often fought before initial investments in a technology are made by the firm. Once an innovation is brought into a hospital, staff must learn it. What were the variables you saw in a team learning a new technique or technology?
Most people think that the skills of the individual surgeon are the most important driver of success, but we found that what really mattered was how the entire surgical team was managed and how it prepared for the adoption. We found that teams that learned a new technique fastest had a very different approach to adoption. They didn't just look at adoption as a technical problem, but instead focused on what the new technique meant for each member's role and responsibilities. The surgeon's role was critical, not just as an individual user of the technology, but as the leader of the team and the individual responsible for framing the challenge. Where the challenge was framed narrowly as a technical problem, adoption was more problematic. But where the surgeon framed the challenge as one of organizational learning, we saw much more success with adoption. Psychological safety, a concept originally developed by, Amy Edmondson and played a critical role in successful adoption. Adoption was much more rapid in teams where the surgeon promoted open discussion of problems and “speaking up” by individual members.
What role did "psychological safety" play in the ability of a team to master an innovation? Healthcare Management Review PAGE Volume 15 095
Learning depends on the climate you create in the organization.
From your study, what lessons are there to be learned about organizational learning? First, organizational learning is not automatic. Too often it is assumed that with practice and experience, performance improves. That's true on average, but there is a lot of variance. Learning has to be actively managed. Learning depends on the climate you create in the organization. Second, learning depends on the climate you create in the organization. If people are afraid to speak up and discuss problems, you lose a critical source of feedback, and you can't learn without feedback. Finally, learning must occur in real time. That is, while after-action reviews can be helpful, reflection on the spot is often the best source of knowledge. You can't always do this reflection immediately, but the longer you wait, the less you will learn. What can managers in other industries learn from your research when assessing, adopting, and employing technological innovations in their companies? The key lesson for managers is to be aware of the social context, or environment, of their organizations
and to understand what aspects of that context interact with the specific requirements of a given technology. For example, if it is clear that a new technology transfers more responsibility from the leader of a team to the team's members, it is important to think about how that requirement meshes with the social context of the firm. This assessment of fit will help a manager determine whether the technology is incompatible with the social context of the organization and, as a result, should not be adopted. If the technology is compatible, it may be the case that it is appropriate only for particular groups or individuals within the firm. If a manager decides to adopt a new technology for only part of the organization, he or she will need to remain aware of how that decision may affect the relationship between formal or informal social groups within the firm. The key in such situations is for managers to use their knowledge of a firm's particular social context to prevent turf battles from hindering the adoption of technologies that would otherwise improve productivity. Healthcare Management Review PAGE Volume 15 096
SINGULARITY UNIVERSITY Building 20 S. Akron Rd., Moffett Field, CA 94035, United States
The Power of Exponential Medicine Lets look at how technologists are redesigning and rebuilding today's broken healthcare system.
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The Bad News: Healthcare today is reactive, retrospective, bureaucratic and expensive. 타 Doctors spend $210 billion per year on procedures that aren't based on patient need, but fear of
liability. 타 It takes on average 12 years and $359 million to take a new drug from the lab to a patient. 타 Only 5 in 5,000 of these new drugs make it to human testing. From there, only 1 of those 5 is actually
approved for human use.
The Good News: The disruption and transformation of medicine is happening right now. That's why each year Peter Diamandis work with Dr. Daniel Kraft, head of the Medicine track at Singularity University, to hold an amazing 3-day event that brings all of the coolest and most powerful technologies together at an event called Exponential Medicine. If you are interested in or involved in medicine, technology, or the future of healthcare, you need to be at this event. Healthcare Management Review PAGE Volume 15 099
The Power of
Exponential Medicine
W
e are in the midst of a (medical) revolution driven by exponential technology: artificial intelligence, sensors, robotics, 3D printing, big data, genomics and stem cells. Today's $3 trillion healthcare industry is in the deceptive phase of its march towards dematerialization, demonetization and democratization. What does that mean? Imagine a time within the next 10 years when: Ÿ
AI-enabled autonomous health scans provide the best diagnostics equally to the poorest and wealthiest on Earth.
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Large-scale genomic sequencing and machine learning allow us to understand the root cause of cancer, heart disease and neurodegenerative disease and what to do about it.
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Robotic surgeons can carry out a perfect operation (every time) for pennies on the dollar.
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When each of us can regrow a heart, liver, lung or kidney when we need it instead of waiting for the donor to die.
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These breakthroughs are materializing because of the convergence of the following key accelerating technologies.
Artificial Intelligence (AI) & Healthcare: Ÿ
AI will enable better diagnoses and personalized medical recommendations.
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Companies like Enlitic are using AI and deep learning to improve medical imaging diagnostics and tumor detection and integrate medical data to provide better actionable advice for patients and doctors alike.
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Johnson & Johnson is teaching IBM Watson to read and understand scientific papers that detail clinical trial outcomes. Even Apple is partnering with IBM Watson to provide access to health data from mobile apps.
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One such Watson system contains 40 million documents, ingests an average of 27,000 new documents per day, and provides insights for thousands of users. After only one year, Watson's successful diagnosis rate for lung cancer is 90 percent, compared to 50 percent for human doctors.
Sensors & Healthcare: Ÿ
Wearables, connected devices and quantified-self apps will allow us to collect enormous amounts of useful health information.
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Wearables like the Quanttus wristband and Vital Connect can transmit your electrocardiogram data, vital signs, posture and stress levels anywhere on the planet.
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Google is developing a full range of internal and external sensors (i.e. Google's smart contact lens) that can monitor the wearer's vitals ranging from blood sugar levels to blood chemistries.
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The $10M Qualcomm Tricorder XPRIZE is bringing the Star Trek Tricorder to life – not for a doctor or nurse, but for you, the consumer.
Robotics & Healthcare: The precision, accuracy, and mobility of medical robotics will allow us to serve more humans around the world, faster and cheaper.
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Over 3 million surgeries worldwide have been performed by Intuitive Surgical's Da Vinci robotic system using 3D HD vision inside the body, with precise movements that don't have the tremors of a human hand. A new generation of surgery robots under development which can autonomously and perfectly conduct routine surgeries without human error and at a fraction of the cost, demonetizing and democratizing surgery. Telepresence technologies like Suitable Technology's BEAM and InTouch Health will allow top physicians to beam into locations around the world for consultation and rounds at hospitals.
Genomics & Big Data: The cost of genome sequencing has plummeted 100,000-fold, from $100M per genome in 2001 to $1,000 per genome today… outpacing Moore's Law by 3x Ÿ
At Human Longetivity Inc. our mission is to accumulate the largest genomics data set ever. HLI will sequence over 1 million full human genomes, microbiomes, MRI body image scans, metabolomes, and more…
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Next, with that large data set, HLI be able to unlock the secrets of our biology. We'll find insights into and cures for cancer, heart disease and neurodegenerative disease, and ultimately extend the human lifespan.
3D Printing: Stem Cells: On-demand manufacturing will make medical devices cheaper and more readily accessible to millions, and it will make scarce resources like organs-for-transplant abundantly available Ÿ
3D Systems is 3D printing precise dental and anatomical models, custom surgical guides, implantable devices, exoskeletons, hearing aids, prosthetics and braces for scoliosis and other applications.
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Students at Washington University 3D printed a robotic arm for about $200. Traditional robotic limbs can run $50,000 to $70,000, and they need to be replaced as children grow.
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Dr. Anthony Atala's team and companies like Organovo are 3D bio-printing with cells to produce tissues, blood vessels and even small organs.
We are now in the earliest stages of stem cell therapy development. Future therapies will be transformative and, frankly, mind-boggling. Ÿ
Stem cell therapy promises tissue regeneration and renewal – and thus a “cure” for everything from blindness to spinal cord injuries, Type 1 diabetes, Parkinson's disease, Alzheimer's disease, heart disease, stroke, burns, cancer and osteoarthritis.
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In 2012, researchers at Cedars-Sinai reported one of the first cases of successful therapeutic stem cell treatment – they used patients' own stem cells to regenerate heart tissue and undo damage from a heart attack. Credit:
Peter Diamandis Abundance 360 Healthcare Management Review PAGE Volume 15 101
TIMELINE Originally published in h+ magazine Hplusmagazine.com
2020 People from all background and of all ranges of ability will acquire valuable new knowledge and skills more reliably and quickly, whether at school, work or at home. Communication and cooperation across barriers of culture, language, distance, and professional specialization will increase the effectiveness of groups, organization, and multinational partnerships. Invulnerable data networks and superior intelligence gathering systems will improve National Security. Effective measures against biological, chemical, radiological, and nuclear attacks will be available Lightweight, information-rich war-fighting systems, uninhabited combat vehicles and adaptable smart materials will transform warfare. New tools and improved understanding of human creativity will expand the creative potential of artists, architects, engineers and designers. Improved awareness of the cognitive, social and biological forces operating in our lives will enable better adjustment, creativity, and daily decision-making. Factories will be organized around converging technologies and increased capabilities of human-machine, allowing the maximum benefits of mass production and custom design. Agriculture and the food industry will increase yields and reduce spoilage as cheap, smart sensors monitor the condition and needs of plants, animals, and farm products. The work of scientists will be revolutionized by approaches pioneered in other sciences.
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2025 Robots and 'software agents' will operate on principles compatible with human goals, awareness, and personality. The human body will be more durable, healthier, more energetic, easier to repair, and more resistant to many kinds of stress, biological threats and the aging processes. A combination of technologies and treatments will compensate for many physical and mental disabilities and will eradicate some conditions altogether.
2030 Fast, broadband interfaces between the human brain and machines will transform work in factories, control cars, and enable new sports, art forms and modes of interaction between people. Machines and structures, from homes to aircraft, will be constructed of materials that have exactly the desired properties, including the ability to adapt to changing situations, and increase energy efficiency and environmental friendliness. The ability to control the genetics of humans, animals, and agricultural plants will greatly benefit human welfare; widespread consensus about ethical, legal, and moral issues will be built in the process. Transportation will be safe, cheap, and fast, due to universal real-time information systems, extremely high-efficiency vehicle designs, and the use of synthetic materials and machines fabricated from the nanoscale for optimum performance. Formal education will be transformed by a unified but diverse curriculum based on a comprehensive, intellectual model for understanding the architecture of the physical world from the nanoscale through the cosmic scale.
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