HEALTHCARE: THREE STORIES AT THE BOTTOM OF THE PRYRAMID
THE MOP-UP On June 25, 2003 Sunil Bahl, WHO physician and medical officer sent an email to key people at the WHO, UNICEF and the Indian Government about an incidence of polio in Karnataka. A young boy had developed it. The case was in a part of Karnataka that had the history of being the worst. If the disease expanded from there, the decades long worldwide fight against polio was all but over. Pankaj Bhatnagar, was the WHO paediatrician responsible for the operation. Along with a team of three young medical officers, he conducted a mop-up which went door to door and inoculated 4 million children in thirteen districts in Karnataka. In three days. They worked with thirty-seven thousand vaccinators, four thousand health care supervisors, rented two thousand vaccine carriers. They vaccinated every child under the age of five. They covered 90% of the target population of 4.2 million - the percentage required to shut down transmission of the disease. What was remarkable, what that all of this was done with cell phones and no software mediation. Closing: Imagine the impact on humans if these operations were mediated by software experiences designed to amplify the efforts of dedicated professionals. source - Better, the mop-up
WARTIME PERFORMANCE The Iran and Afghanistan wars marked a historic reduction in the lethality of battle wounds for the U.S. Although more U.S. solders have been wounded in combat in the current war than in the Revolutionary War, the War of 1812, and the Spanish American War combined, and more than in the first four years of military involvement in Vietnam, we have substantially fewer deaths. Just 10 percent of the wounded American soldiers have died. How was this achieved ? By simple, almost banal changes that produced enormous improvements. They made a science of performance, to investigate and improve how well they use the knowledge and technologies they already have at hand. They started by trying to extend the "Golden Five Minutes" for soldiers, during which trauma victims can be saved if treated. This lead to an assembly line approach to medical care. On arrival of the wounded, the forward surgical team, operating on the field out of rapidly deployable shelter, focused on damage control, not definitive repair. They sought to keep their operations under two hours and provided no more than six hours of post operative care. Having stabilised the injuries, they shipped the solider off to another team at the next level of care - two Combat Support Hospitals, or CaSHes in four locations. These 248 bed hospitals with operating tables, speciality surgery and radiology and lab facilities limited the stay to three days Soldiers requiring longer care were transferred to level IV hospitals - one in Kuwait, one in Rota, Spain with the main one in Landsthul, Germany. Those requiring more than thirty days of treatment are transferred home, to either the Walter Reed or Brooke Army Medical Centre in San Antonio, Texas. The average time from battlefield to arrival in the United States is now less than 4 days. In Vietnam, it was forty days. The system has worked. Closing: What is remarkable is that this performance was achieved, using notes taped to the body. Imagine the improvement in performance and care we could bring with software mediated experiences designed to work with surgeons. source - Better - Causalties of War
THE ARAVIND ASSEMLY LINE Aravind Eyecare treats 2.4 million outpatients and does 286,000 cataract surgeries every year. There are 24 million blind in the world. It is the largest opthamological institute in the world. In its business model, only 30% of its patients pay. The remaining are treated free or nearly free - this covers thousands of blind poor. It makes a 35 percent operating profit. It has perfected an assembly-line technique of surgery that increases the surgeon's productivity by a factor of ten. An average ophthalmologist operates on 250 to 400 patients a year. An Aravind ophthalmologist operates on 2000 patients a year. This is how it works : The day starts at 7 a.m. for doctors. Nurses come in at 6:30 a.m. and prepare the patients for each day. Patients are scheduled for each doctor. By 7:15 am, two patients are on two adjacent operating tables. One operation theatre has four operating tables laid side by side and two surgeons handle these four tables Each patient has two nurses. One assists the doctor and the other, called a running nurse, brings surgical instruments from a sterilization area about twenty-five metres away. By the time the surgeon finishes with one patient, the other one on the adjacent table is ready with the microscope focused on the eye to be operated on. The operated patient is moved out and the third one is brought in and kept in operational readiness.
The moment the surgeon finishes with the second patient, he swivels to the third with minimal loss of time and effort. It's common for each surgeon to do about twenty five to thirty surgeries between 7 a.m. and 1 p.m. There are no operations in the afternoon and the theatre is scrubbed and kept ready for the next day's surgeries. The surgeons spend the rest of the day in either outpatient work or research. The paramedical staff is the key to the success of its business model. They take up a lot of what would be doctor's responsibilities in other hospitals. They do refraction testing, counselling and help patients decide
what kind of surgery or treatment to go in for, freeing the doctors time for more surgeries and medical consultation. The staff are girls recruited from villages and just need to have passed the tenth standard. After intensive selection they are put through an orientation programme for a month, which highlights the heritage, the value system and the culture of Aravind. Everyone attends this. During this time they are partnered with mentors -exceptional performers at a similar job - who act as inspiration and inculcate the Aravind way of life into them. They are trained intensively for two years and then placed as nurses. Aravind has its own syllabus and training. They operate without supervision. Every day three thousand people operate on nearly three hundred. But there is no chaos, no rush, nothing. There's an all pervasive calmness. No yelling. Closing: Aravind is the largest institute for ophthalmology in the world, leads by example and has a vision of eradicating needless blindness in the world. It's current ambition is to reach a billion people. What's remarkable is that the Aravind system has little or no software mediation. Imagine the impact on human lives if we crafted software mediated experiences to further their cause. source: Making Breakthrough Innovation Happen